Mar 15, 2014 - that call for new solutions and interventions. ... methodologies at work for activating innovative services ...... conferences with the lead expert to.
Healthy Ageing Cities’ Action for Healthy and Active Ageing
Baseline Study
by Fiorenza Deriu (LE) 15th March 2014
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FOREWORD
The older population in Europe is growing at a considerably faster rate than that of the world’s total population. The number of older persons in Europe has tripled over the last 50 years and will more than triple again over the next 50 years. The older population is also undergoing a process of demographic ageing: the most rapidly growing group is that aged 80 years and over. The shift in population age structure, due to the combined effect of both increasing longevity and decreasing fertility, has a profound impact on a broad range of economic, political and social conditions. Demographic ageing is at the same time a challenge and an opportunity in a society that is changing its ‘face’: fewer young people and young adults, older workers, increasing number of pensioners and very elderly people. Within this framework people’s needs as well as older people’s expectations on life quality opportunities change. Hence, new forms of solidarity and of intervention must be developed promoting cooperation between generations. Cooperation based on both mutual support and exchange of experiences and skills is welcome.
This well-known global trend is also ongoing in Italy and the city of Udine has given special attention to developing policies aiming at active ageing with a particular attention to citizens’ engagement and intergenerational initiatives within a deliberative and participative methodological perspective. The first step to move to cope with these changes and to provide effective services is an overall understanding and analysis of the local context and the living conditions of citizens, in particular vulnerable groups. Focusing on older age, different approaches have been combined to raise awareness of demographic ageing and better meet citizens’ needs through more effective strategies and health policies. Much has been done in Udine to promote healthy lifestyles and health literacy within the community to increase awareness on the importance of an active and healthy ageing.
This experience will be fully put at partners’ disposal within this transnational network.
The State of the Art 3
General presentation Over the last decades increasing longevity throughout the countries of the European Union (EU) has resulted in a higher number of individuals reaching old age. This trend is mainly due to two factors: the low mortality recorded among those people born after the Second World War and the improvement in life expectancy of those aged 65 and over. These trends have led to an increase in the number of the oldest old population (aged 80 and years and over) (Oeppen and Vaupel, 2002; Rau et al., 2008; Meslé and Vallin, 2011; Marc Luy et al., 2011; Crimmins et al., 2011). At the same time, the steady decline in fertility, which started in different periods and proceeded at different paces among European countries, has had a significant impact on the decrease of the young
below the EU-27 average (18.2%); immediately followed by France with a percentage of over 65 at 17.6%, very close to the EU-27 level. On the other hand, Italy records the highest percentage of over 65 (21,2%) in 2013, more than one fifth of the total population. Lithuania is currently in line with the European average (graph. 1). Graph. 1 - Proportion of population aged 65 and over - % of total population – 2009 and 2013
population. The combined action of increasing
longevity
and decreasing fertility has driven a common growing trend in aging, in relative terms, in almost all EU-27 countries1 (National Research Council, 2001; Gaymu et al., 2008; Christensen et al., 2009). This ongoing process has led to major changes in economic and social relations, impacting on growth and public spending, making it difficult to maintain sound and sustainable public finances in the long term (Zaidi, 2010; Deriu, 2011). Oldest-old aging societies are pressing governments “to implement
health and social policies specifically aimed at coping with the fast growing number of people in their ‘third’ and ‘fourth’ age” (Caselli et al., 2003:45-46). If we look more specifically at the countries involved 2 in the “Healthy Ageing” Project , it is worthwhile noting that they are not homogeneous when considering both their population trends and demographic structure. Actually, if we move on consider the proportion of people aged 65 and over in 2013, we can observe on the one hand, that United Kingdom has the lowest percentage (17.2%), one percentage point 1
Austria, Belgium, Denmark, Finland, France, Germany. Iceland, Italy, Greece, Luxembourg, Netherlands. Norway, Portugal, Spain, Sweden. 2 The city partners of the project are Brighton & Hove and Edinburgh for the United Kingdom; Klaipeda for Lithuania; Grand-Poitiers for France. Udine, a city of the Northern Region of Italy, is the Lead partner of the transfer network.
Source: Eurostat Indicators Database
The pattern becomes more critical if we consider the proportion of the oldest old population (80 years and over) that since 2000 in the EU-27 has risen considerably from 3,3% up to 5.1% in 2013. Italy represents the oldest country in Europe with a 6.3% figure - well above the European average - while United Kingdom and Lithuania record lower percentage levels (4.7% and 4.8% respectively). France (5.6%) is in the middle according to the data shown in graph. 2. The combined effect of increasing longevity and decreasing fertility is impacting on population structure resulting in an unbalance between adult and elder generations so that the economic burden of an increasing amount of elderly people (persons aged 65 and over) is sustained by a diminishing population aged 15-64. This is the reason why old age dependency ratios are steadily growing all over Europe. In 2013 the average level of this indicator was at 27.5: it means that for every four adults there is an older person to be sustained. Most of the European countries are experiencing this trend and recent projections have foreseen a fast increase in the old-age dependency ratio that will reach in 2070 in the EU-28 the 49,35 threshold (graph. 3).
Graph. 2 - Proportion of population aged 80 and over - % of total population – 2009 and 2013
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Graph. 3 - Old age dependency ratio trend and projection – 2009 – 2070 by selected countries and EU-28 60 50 40 30 20 10 0
2009
2010
2011
2012
2013
2030
2050
2070
EU (27 countries)
25,7
26,1
26,3
26,9
27,5
39,01
49,43
49,35
France
25,4
25,6
25,9
26,7
27,5
39,05
43,78
44,21
Italy
30,9
31,2
31,3
32
32,66
40,79
52,92
53,59
Lithuania
25,4
25,6
26,6
26,9
27,2
47,34
51,88
34,47
United Kingdom
24,3
24,6
24,9
25,6
26,37
34,86
40,6
42,43
Source: Eurostat Indicators Database Among the countries involved in the “Healthy Ageing” Project, at that date Italy will be the only one to be far above that EU-27 threshold, reaching a 53.59 old age dependency ratio. France and United Kingdom will register figures quite below the EU-27 average (respectively at 44.21 and 42.43). Lithuania will be the only country of this group where in 2070 a significant decreasing on this indicator could be registered. The main factors driving population ageing EU population ageing is the result of two underlying trends: a)
b)
low fertility rates
(1,58 children born per female in 2012 in the EU-27 countries on average);
increasing life expectancy for both males and females (77.5 and 83.1 in 2012 in the EU-27).
As far as the first point is concerned, the fertility rate pattern among the countries involved in the “Healthy Ageing Project” is quite different. Italy has one of the lowest fertility rates and it is still far from reaching the EU-27 threshold even if its trend is steadily increasing. France and United Kingdom report the best figures with respectively 2.01 and 1.92 in 2012 (close to the level of population replacement); Lithuania is in the middle with a 1.60. It is well known that France provides women with services supporting the work-life balance according to a system of social policies based on a gender mainstreaming approach. In UK, according to a strategy more oriented to the market, services supporting family choices are actually available for women. Projections by 2030 point out a steady increase in total fertility rate (TFR) all over the EU countries. Anyway, according to recent projections, these positive trends in TFR do not seem to be able to contrast the population ageing process. This question is considerably related to the levels of
longevity
reported in these countries. In fact, it is worth noting that a general increasing trend in life expectancy levels is ongoing all over Europe even if in Lithuania figures are far below the EU-27 average fixed in 2012 at 83.1 years for women and 77.5 for men. Lithuania reports a life expectancy of 79.6 years for women and 68.4 for men, 3.5 and 9 p.p. respectively under the European threshold. Italy shows the best performance in longevity if compared with France and United Kingdom but the best case of female longevity is France (tab. 1).
Table 1 – Life expectancy in selected countries 2012 European Life Life expectancy countries expectancy (Females) (Males) EU-27 83.1 77.5 Italy 84.8 79.8 France 85.4 78.7 Lithuania 79.6 68.4 United 82.8 79.1 Kingdom Source: Eurostat Indicators Database Life expectancy data should be analysed alongside figures on healthy living in later years (e.g.: at 65 years). In fact, population ageing is expected to considerably increase the need for care services among elderly people if ageing is not accompanied by preventative actions and initiatives aimed at maintaining people mentally and physically active.
Healthy Life Years (HLY) at age 65 measures the number of
The
indicator
years that a person at age 65 is still expected to live
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in a healthy condition. HLY is a health expectancy indicator, which combines information on mortality and morbidity. The data required are the agespecific prevalence (proportions) of the population in healthy and unhealthy conditions and age-specific mortality information. A healthy condition is defined by the absence of limitations in functioning/disability.
rest of his or her life to the current mortality conditions (Eurostat Indicators Database – Metadata).
Graph. 4 - Healthy life years at age 65 - disabilityfree life expectancy (DFLE) by selected countries
Italy is the only country among those considered
a)
women live longer but not in better health than men. For this reason, planning policies oriented
According to the data shown in the graphics above, even if Italy is the country where the life expectancy of women reaches the highest value, it does not mean that the years gained are lived in good health. in this analysis, where the healthy life years at 65 indicator is lower for women than for men (7 years vs almost 8). So,
ITALY M
to support ageing among women represents a F
means that healthy ageing should represent a field in which experience new solutions for improving life conditions in later ages. France and United Kingdom are two best performing countries, where HLY indicator varies between 9 and 11 years. Anyway,
b)
FRANCE
F
France while the female HLY indicator is improving, that for males is decreasing; in United Kingdom both women and men HLY are decreasing converging to a common figure the data show quite different trends. In
M
c)
F LITHUANIA
M
d)
F UNITED KINGDOM
In Lithuania the HLY indicator is particularly low: it is 5.5 for men and about 6 for women. It priority for local governance.
M
The indicator is also called disability-free life expectancy (DFLE). Life expectancy at age 65 is defined as the mean number of years still to be lived by a person at age 65, if subjected throughout the
(about 10.5 years). Even if in these countries the life expectancy in good health at age 65 is higher than in Italy and in Lithuania they are actually facing new challenges that call for new solutions and interventions. The “Healthy Ageing” Project provides these countries, and more specifically the city partners in the pilot transfer network, with the opportunity to share experiences and to find out new ideas for improving life quality at later ages. It is quite clear that policies priorities and approaches are different in these four contexts. Anyway, there is a common denominator affecting Grand Poitiers, Brighton & Hove and Klaipeda: the weak commitment of managing authorities, public managers and politicians on this issue and in particular on older people’s needs. In light of a general public spending retrenchment, managing authorities seem to be more keen on investing on policies oriented to young generations. So, in all these three cities it is becoming increasingly important motivating managing authorities to support initiatives based on intergenerational approaches. This is the case of Grand Poitiers, that
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is particularly interested in transferring the microproject “move your minds…minds on the move”; the case of Brighton which is interested in new experimental forms of Urban Gardens to involve students and sustain the intergenerational exchange. It is quite different the situation in Edinburgh where a wide and well articulated action plan on active and healthy ageing is already ongoing, offering a variety of opportunities and services to older people. Anyway, Edinburgh is actually interested in finding out new ideas as well as experiencing new methodologies at work for activating innovative services to cope with new challenges in a more effective way. Udine, a city of the Eastern Region of Italy, is the lead partner within this network, having implemented a number of activities and experimented new methodologies that have significantly contributed to improve active ageing at local level. This project represents also for Udine an occasion for learning from other cities innovative solutions for increasing the supply of services for the active and healthy ageing of older people.
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THE GOOD PRACTICE OF UDINE DESCRIPTION OF THE MAIN ACTIVITIES TO BE TRASFERRED IN THE RECEIVING CITIES
UDINE: Description of the good practice Background information on the «giving» city: the Municipality of Udine Udine is a small city of Friuli Venezia-Giulia, a region located in north-eastern Italy in the South of Europe. It has a population of almost 100,000 inhabitants in an area of 56,81 square kilometres (fig. 1). Fig. 1 – City of Udine
In 2013, elderly people were 25.5% of total population and the dependency ratio (people aged 75 (fig. 4) and 1 with carers. In a second phase, 3 more focus groups were added: 1 with public service providers and 1 with the private ones; 1 with volunteers. In each focus group 8 topic areas (fig. 5), illustrated below, were addressed in order to put into evidence barriers and gaps but also to collect suggestions for improvement. Fig. 4 – Older people Focus Group in Udine
Fig. 5 – Age-Friendly Cities topic areas (Who, Geneva 2007)
Fig. 7 – Walking group Project
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Fig. 8 – Gentle fitness
d) promoting opportunities for older people to
remain physically, mentally and socially active as long as possible through actions and initiatives at the local level. The city of Udine has tried to create supportive environments and established patterns for healthy living through food and mobility policies oriented to the elderly. A number of micro-projects have been started to enable and encourage increasing physical and mental activity among population in later years as a very effective way of preventing and lowering the high costs associated with health and social services. One of these Projects is named “Walking
groups”: it involves three times a week groups of about 15-20 older people who meet at a station point for a walk of 10-15 km a day in a green park (fig. 6 e 7). It is an occasion to meet one other, to socialize, to exercise and remain physically active. There are six walking groups in Udine in different city districts. They are combined with another indoor physical activity programme of gentle fitness (fig. 8). Fig. 6 – Walking group Project
There is another very interesting intergenerational project, thought to make young and elderly generations working together. It is named “CamminaMenti” - Move your minds… minds on the move and it provides elderly people the opportunity to participate into a cycle of seminars and laboratories hosted by the city districts (fig. 9). There are several topics of interest: memory, popular traditions, foreign languages, intercultural laboratories, wellbeing, spice lab, botanical and cooking, unusual tours in the city, music, etc. Fig. 9 – Move your minds…minds move…Camminamenti Project
on
the
Each topic is developed along 8 seminars or labs lasting 3 hours. The Project has been
organized with the cooperation of a group of students attending an advanced degree in Nursery at the University of Udine.
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Fig. 10 – The walking group members together with the city partners representatives – Study Visit in Udine 5-7 March 2014
The products of the plots represent also a significant saving in money for conductors on their expenditure for vegetables. There are currently 4 Urban Gardens in Udine: each one is made of about 20 plots managed by schools free of charge and, at a fee of 4 euros a month, by families, individuals and associations. The plots are allocated according to a public call launched every 5 years by the Municipality and/or whenever a number of plots becomes free.
Political and strategic context
Another important initiative that enforces an independent life among the elderly is concerned with the “Urban Gardens”: an occasion of socialization and aggregation of people of different ages. Green areas where people of all ages start rebuilding relationships and socialization spaces (fig. 11). Families, single individuals, schools, associations meet each other and exchange experiences and skills on farming and raising plants, vegetables and any kind of botanical herbs; they cooperate to create a network of solidarity and mutual help in managing and caring their plots. Fig. 11 – Urban gardens - Study Visit in Udine 5-7 March 2014
The practice of Udine is mainly focused on social inclusion and active participation of elderly people into the life of the city. In such a sense, this practice is coherent with the objectives of the flagship initiative called “European Platform against poverty and exclusion” which falls under the inclusive growth objective of the EU 2020 Strategy. In particular it matches with at least 3 over 5 areas of action: a) a more effective use of EU funds to support social inclusion; b) the promotion of consistent evidence of what does and does not work in social policy innovation; c) the work in partnership with civil society to support more effectively the implementation of social policy reforms. Moreover, this practice is fully consistent with the Strategic Implementation Plan for the European Innovation Partnership on Active and Healthy Ageing (Brussels, European Commission, 2011). Through this Strategy the European Commission aims to enhance European competitiveness and tackle societal challenges. In this framework active and healthy ageing represents a major societal challenge common to all European countries, and an area which presents considerable potential for Europe to lead the world in providing innovative responses to this challenge. In addition to that, it is worthwhile noting that Udine has been the leading city of the Healthy Ageing Sub-Network within the WHO Healthy Cities Project for several years, gaining experience by working with WHO experts and advisors and by getting in contact with plenty of initiatives and actions organized by other cities to promote the quality of life of older people.
This experience will be fully put at partners’ disposal within this transnational Urbact network.
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The involvement in Healthy Cities and the strong commitment to the theme of Healthy and Active Ageing have also contributed to a re-definition of priorities at the local level and a re-organisation of services. By this way, the City of Udine has developed a Health Development Plan, a global intersectoral plan where all planning and operational tools are mutually connected, and the public and private bodies directly or indirectly address the citizens’ health problems. Finally, the planning activity of the Municipality of Udine is also rooted in another strategic project for sustainable planning: the Agenda 21, an Action Plan promoted by UN to start sustainable development in the 21st century. The Local Agenda 21 is a plan to translate the general objectives of Agenda 21 into concrete objectives at the local level. The Agenda has been defined by the Department of Urban Planning of the City of Udine and many connections have been activated between Agenda 21 and Healthy Cities. In this stimulating and well connected context the good practice of Udine has flourished.
Monitoring and evaluation system The various activities implemented in Udine with respect to this project have been monitored and evaluated by using different tools. For what the Healthy Ageing Profile and the Vancouver Protocol are concerned, the results achieved by Udine in implementing the corresponding activities have been annually evaluated by the WHO staff. As a matter of fact, being part of the WHO European Healthy Cities Network implies some mandatory steps for cities during the process of developing and implementing activities at the local level. Udine has produced every year an Annual report following the standards given by the WHO Guidelines concerning both objectives of the interventions and the methodology adopted to carry them out. The Report prepared by the City of Udine has been assigned for evaluation to some advisors, external to the staff and experts in the core themes. The City of Udine is considered a lead Municipality in developing this good practices because it has reached success where other cities have failed. This has happened because Udine has been able to activate processes at various levels: at citizens’ level, at meso-level, and at political level. The political leadership and governance has played a crucial role in this experience of building success , favouring a more fluid communication
between public administration, different sectors of the civil society and citizens themselves. The evaluation activity has been also carried out with regard to the experience of the “Move your minds…minds on move” Project. A pre and post-test tool has been implemented and submitted to the participants to the seminars and laboratories held at district level for being filled in. Through this tool the staff of the Project has tried to “evaluate” changing in mood, cognitive skills or in some aspects of the everyday life among those who had participated into the Project. At the end of the experience, participants seemed to be more stimulated to work in a team, to make proposals for the future, to do outdoor activities and/or sports, to go outside and meet new people and get new friends. These data suggest that the project “Move your mind…mind on move” has got a positive effect on the participants helping them to fight solitude and isolation. The high level of satisfaction with the topics addressed during the seminars and labs as well as with the activities and the clarity of the teachers, suggest that the organisational team was efficient in planning and implementing the project. Important documents that represent all the knowhow produced by the experience of Udine will be used as a toolkit for the transfer of the good practice within the Urbact Network. Here below the most relevant ones: -
-
-
-
the Guidance for producing local Health Profiles of older people, which provides quantitative and qualitative information on the health and the living circumstances of older people, made of three parts: population, health and social care systems, social picture; the Age Friendly Cities Guide, which presents the objectives, methodology and results of a consultative process with older people, carers and providers of services in the public, private and voluntary sector, to discover the existing “age-friendly” urban features as well as the barriers to active ageing; the description of the methodology followed for producing the health maps with regard to the population distribution on the city territory and the evaluation of the demand and provision of public, health and social services offered to the community; pre and post-test questionnaires for evaluating participants’ satisfaction with
-
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seminars and labs aimed at improving a mentally active ageing; an observational grid to study the dynamics ongoing in the working groups of elderly people participating into these projects.
Fig. 12 – Model of integrated governance
Innovative elements and novel approaches One of the most important strengths point of the good practice of Udine, in a whole perspective, is the strong political will to make actors work together in an integrated way. Hence, the model of integrated governance represents the most challenging factor of success of this good practice where three levels of governance have effectively cooperated towards the same goal (fig. 12): a) at micro-level, individuals and their families; b) at meso-level, associations, public bodies, and agencies; c) at macro-level, the Municipality through its administrative and political representatives. The City government has promoted a participative process that has favoured the engagement of citizens and of other stakeholders animated by different interests. Hence, the two main values in which this method is rooted are: the intersectoral cooperation and the community empowerment. Anyway, the most innovative aspect of this practice is the methodology and the close connection among all the interventions put into action.
There is a strict linkage between the Health Profile, the Health Maps, the Vancouver Protocol, the Health Plan and the activities and micro-projects started. The Health Profile has determined the starting picture, in both qualitative and quantitative terms, of the population’s health and the factors that are likely to influence it at local level (Who Handbook, 1995); the Health Maps have integrated this first city picture matching the population distribution to social and socio-health services on the territory. Anyway, even when the picture is rich of details the decision makers could not be able to meet people needs.
In fact, there are three crucial points to consider with this respect: a) the demand does not always correspond to the needs, as people who apply for services are not always the same who need them; b) there is an implicit demand for services; c) the same need can be faced by different kind of services. The use of the Vancouver Protocol methodology has enabled the City to involve citizens and local actors contributing to clarify the terms of the demands of social and socio-health services as well as to empower community itself. The qualitative approach of the focus groups is particularly effective in a field where building alliances between citizens and city government is really challenging. The focus groups have given voice to people, service providers, volunteers, favouring the meeting of responsibilities as well as the integration of technical and professional demands with social and political demands. The last phase of this virtuous circle is concerning with the redaction of a Health Plan, a strategy for a healthy city, where a number of projects, services and interventions are put into action to meet people need and priorities.
Funding Although it is not easy to define the exact amount of funding necessary to cover all the different actions, the total cost of this project is estimated to be about 70,000-100,000 euros. Most of the activities have been carried out with professional resources already in charge to the city administration, to local health agencies, to sectoral Departments. There are also some internal and external subjects that play a crucial role in this practice: e.g. the Department of Statistics of the Municipality; the University, in order to acquire experts able to analyse data collected via ad hoc evaluation tools;
the public health agencies, to get professionals with experience in social research, etc. Anyway, it is possible to estimate the following costs in detail:
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1. Health Maps: 2 professionals (1 professor and 1 collaborator); 10,000 euros for 2 months of work. Funded on the budget line of “Città Sane” WHO Project. Partners have to consider that the University of Udine had got the GIS software and the data needed for mapping population and services were free of charge. So, it could happen that in some receiving cities the data must be bought or acquired in some way; 2. Vancouver Protocol and the facilitation of 8 focus groups: 2 professionals internal to the city administration; 3. Urban gardens: starting a green area made of 18/20 plots costs 50,000 euros. The maintenance is at zero costs because conductors pay a fee of 4 euros a month and take care of the plot assigned. Each plot has a surface of 30 mq and its production can get rid 1 family of 5 people for 1 year of buying vegetables. A money saving of 1,000 euros a year has been estimated. A part of the costs have been covered by 5‰ funding coming from citizens tributes destinated to the Municipality for social services; 4. “Move your minds…minds on the move”. The costs are estimated to 25,000 euros a year and they are covered by the 5‰ of citizens tributes destinated to the Municipality for social services.
Project assessment Most of the activities described in these pages are still ongoing and the city governement is willing to continue funding them in the next years. Obviously not all the actions follow the same pace. At the moment the Municipality is not planning to renew the participative process based on the Vancouver Protocol to raise problems, identify priorities and suggestions for action because the informative potential of this first wave of action is still valid and effective. There are plenty of activities and micro-projects that are going to start on the basis of the information collected through this methodology and probably it will take some years before renewing the consultation process of elderly people and social actors. On the other side, there are activities that need much more continuity. This is the case of the City
Heath Profile. The Office of Statistics of Udine will update the indicators needed for building the City Health Profile and according to the most recent population Census data a revision of elderly people distribution on the territory will be carried out in cooperation with the University of Udine. The Healthy Ageing Profile (HAP) represents also the first step towards the development of a Healthy Ageing Observatory, following the idea of matching the indicators build for the HAP with the Active Ageing Index, which is a measurement system designed by the European Union. At the moment Udine is collecting plenty of information regarding all the aspects of the quality of life for older people in Udine: such as employment, health and care services, lifestyles, institutionalization, participation in voluntary associations, social inclusion in terms of participating in local events and initiatives organized by the community. The Municipality is also studying a way of mapping accidents occurred in the city to elderly people, in order to plan interventions for a more age-friendly urban environment. Other social and socio-health services are under decision for future mapping (e.g.: architectural barriers, crossing lines etc…). Most of the micro-projects activated in a preventive perspective, to maintain people mentally and physically active in later ages, are going to be continued and further developed. The Walking groups are at their fourth stage; “Move your minds…minds on the move” is at its second edition; the Urban gardens are going to start with the fifth area in the city and have also gained funding to develop a mobile “App” to create a real interaction between citizens and public administration to add value at the environment discovering of forgotten places and routes to be returned to collective memory. It would be a good way to address the issue of the digital divide among the elderlies, giving them the opportunity to recuperate to the City memory landscapes ignored by most of the people.
Main issues and problems The main issue of the good practice of Udine is its integrated model of governance. It is at the same time a strength point and a challenging barrier to the transfer of this practice in other contexts. As prof. Geoff Green has shown in his presentation during the study visit in Udine, the WHO is strongly committed in spreading the adoption of a social model of health, mainly based on getting over the conventional “Silo” accounting in favour of a more dynamic and integrated one (fig. 13).
Fig. 13 – Domains of Municipal influence – Healthy cities intersectoral approach to health development – prof. Geoff Green, WHO Expert – Study visit 5-7 March
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The rationale of this model is mainly based on an integrated model of governance where each Department invests economic resources in actions impacting on different fields increasing the economic return as well as the social remuneration of the investments done. This model offers concrete evidence of how the well known approach of “social investment” can be put into practice (Hemerijck, 2013; Palier, Palme, 2010). This is the model adopted by the Municipality of Udine to implement the activities described above. Anyway many difficulties and obstacles had to be overcome to get the expected results. The first barrier that Udine has faced at concerned the difficulty encountered by the actors of health policies in working with those committed in other spheres of intervention. How this main obstacle has been overcome? First of all, decision makers, politicians and public managers engaged in different fields of action were sensitised to focus on the health impact of their decisions. Enlarging the horizon of their decisions they were enabled to look at problems from a different perspective and to consider alternative investments opportunities. They were involved in a training session and submitted to a pre and post-test assessment process (WHO DeciPher Project). So, the first challenge was to convince these professionals in getting active part of this change of “paradigm”. At the same time, the City has worked hard in engaging people, citizens, and all those other actors that could participate in the deliberative process aimed at defining the Health Plan of Udine. This is another crucial issue in the transfer of the good practice of Udine. In fact, it has not to be taken for granted that cities succeed in engaging people and stakeholders in public discussion on a specific topic. Probably, the most challenging factor in the transfer of the good practice of Udine in the receiving cities will be the possibility to make all these actors work together according to a more and effectively integrated model of governance.
Udine has overcome this obstacle through a capillar communication plan that has actually favoured the involvement of politicians, stakeholders and citizens on a discussion on healthy ageing. The municipality has not limited its action to contacting local associations and organizations but it has spread out information on the opportunity to take part in the health planning of the city involving medical practitioners, chemists, social operators in order to reach as much people as possible. Hence, information has been further spread by word of mouth among people who experienced the participation into the focus groups (Vancouver Protocol). Coming to more specific problems, one difficulty that some receiving cities could encounter, concerns the mapping of population by the GIS system. At this regard it is worthwhile pointing out that two out of four cities (Brighton & Hove and Klaipeda) have already developed at local level a mapping system of a wide number of services available for elderly people (fig. 14 and 15). Fig. 14 – Maps of services in Klaipeda
What is still lacking is the matching between these maps and the distribution of elderly population on their territory. This is the most challenging point in the transfer of GIS practice. In fact, census data on individuals and their location are needed for implementing GIS mapping. Not all the cities involved in this network have got these data. Fig. 15 – The map of services in Brighton & Hove
In order to solve this problem, during the study visit in Udine, the cities have agreed with the lead
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partner a plan of action: they will firstly check the availability of data as well as the way they have been collected in order to identify with the support of the scholars of the University of Udine the best way to use them for mapping. As an example, the experts in GIS of the city of Klaipeda have already contacted the prof. Fornasin, of the University of Udine, to assess the effective possibility to implement the GIS with the population data at their disposal. This support is guaranteed to all the city partners. To sustain the work of cities in reviewing data needed for building the City Health Profile as well as for mapping, they have been provided with the list of the 22 indicators (and their formulas) and a “data sources check list” in order to get a clear picture of the most critical points.
Success factors, lesson learned and transfer conditions In conclusion the following success factors can be highlighted: 1. the strong political will and the Mayor’s commitment into the implementation of the good practice; 2. the commitment of the City of Udine in other projects and networks working on healthy ageing at WHO level (Who “Healthy Cities Project”, Who “Age-Friendly Cities Project”, the “Vancouver Protocol network” etc..); 3. the adoption of the UN Agenda 21 Action Plan for sustainable development that has led Udine to define the Local Agenda 21; 4. the adoption of a model of integrated governance based on an intersectoral cooperation and community empowerment; promotion of a participative and deliberative process that has favoured the
5. the
engagement of both citizens and other stakeholders at local level (associations, organizations, public agencies, local bodies etc…) According to these success factors, some lessons learnt are listed below: 1. decision makers, politicians, public managers and professionals engaged in different fields of action should be sensitised to focus on health
impact of their decisions at the aim to consider alternative investment opportunities and to work together; 2. methodologies, such as the Vancouver Protocol, oriented to sustain the engagement of a wide number of stakeholders should become an ordinary tool for building knowledge on healthy ageing and on age-friendly cities; 3. the information on both population characteristics and socio-health services represents a key starting point for health planning. Anyway, data collection and reporting is not enough because it is their matching to make the difference. The integrated GIS system of the City of Udine is an example of how the integration of different kind of data can provide policy makers with useful information for decision making; 4. good practices do not necessarily need plenty of funding to be implemented. The experience of Udine shows that it is effectively possible to develop a wide number of initiatives starting from a very modest investment (about 70,000 – 100,000 euros in all) Finally, what are the key conditions that would need to be present in the receiving cities for transferring the practice of Udine? The cities have already set up a Local Support Group (LSG) that is working on how to implement the plan of activities agreed during the kick-off meeting in Paris and in occasion of the Study visit in Udine (5-7 March 2014). The LSGs have a strong commitment to influencing politicians, public managers and professionals decisions with respect to the transfer of the good practice of Udine. In the next pages of this baseline study, it will be better outlined how the processes of transferring are ongoing at local level. The partners have been provided with guidelines and tools explaining the methodology to be followed to implement the City Health Profile as well as the community engagement through the Vancouver Protocol. Assistance will be provided by the Lead Expert of the network in order to favour the process of transferring of these methodologies. Moreover, the staff of the City who has managed the focus groups with elderly citizens, services operators and volunteers is
strongly committed transferring process.
in
supporting
the
An in depth analysis of the implementation of a number of micro-projects aimed at keeping elderly
17
people mentally and physically active in later ages (walking groups, Move your minds, urban gardens etc…) has been carried out. The site visits have favoured the exchange of experience and animated a discussion on how implementing these activities in the other cities. In order to favour the assessment of the actions carried out, the city of Udine has shared with the partners a number of tools, already tested, to evaluate the impact of the projects put into action (questionnaires for pre and post tests; an observational grid for studying the intragroup dynamics etc…).
The working groups
The partners and the “walking group”
Finally, the network is confident with the possibility to transfer most of the activities run in Udine. Study Visit 5-7 March 2014
The partners and Urban gardens The representatives of the Urbact Transfer Network Healthy Ageing – The House of Peasanty
Products of the Urban Garden The discussion
Brighton & Hove: engaging elderly people against solitude and isolation 18 The local context and the policy
challenges The City of Brighton & Hove (UK) has a population of 482,6about 270,000 (ONS, 2011) living in a boundary which covers 31,5km2. It is located in South East England.
Udine has demonstrated good practice in i) data analysis and GIS mapping; ii) preventative services for older people; iii) consultation and engagement with older people, which can be shared. Edinburgh has also demonstrated through recent work on implementing an Age Friendly city approach in B&H, networking with other Age-Friendly Cities through the UK Network that it wants to learn from other cities and apply learning to how services for older people are planned, developed and delivered. Table 1: Population by age and gender as a % of total population (number of people in brackets) ‐ Mid Year Estimate 2011 All people
Independence is important to older people; older people’s home care services are increasing in line with a decrease in care home placements. Assistive technology is being actively promoted demonstrating positive outcomes; however there are risks of increased isolation which can affect older people’s wellbeing.
England South East
273,000 53,107,000 50% (136,800)
51%
51%
Males
50% (136,200)
49%
49%
0‐15
16% (44,500)
19%
19%
16‐64
71% (192,700)
65%
64%
13% (35,800)
16%
17%
Working age
69% (187,300)
62%
61%
Pensionable age
15% (41,200)
19%
20%
Source: Office for National Statistics (ONS) Mid Year Estimates 2011 available from http://www.ons.gov.uk/ons/publications/rereference-tables.html?edition=tcm%3A77-262039
Fig. 1: Population pyramid, 2011 Mid Year Estimate and 2021 projection, Brighton & Hove
The City is currently a high user of care homes but is committed to providing alternative accommodation options, in particular extra care housing. Ideally new models will include provision designed by older people, keeping them active and less socially isolated. Baby boomers have different aspirations and are keen to lead service design, which could lead to innovative and inclusive solutions for older people. (Brighton & Hove JSNA 2013, Ageing Well, available at www.bhlis.org/jsna2013). Source: Office for National Statistics 3
Office for National Statistics. Interim 2011 based sub national population projections. http://www.ons.gov.uk/ons/publications/re‐ reference‐tables.html?edition=tcm%3A77‐274527 [Accessed 12/06/2013]
8,652,800
Females
65+
Although the proportion of older people living in the City has fallen in recent years, the population aged 65 years or over is predicted to increase and become more ethnically diverse. The largest projected increases are in the 70-74 and 90 and over age groups (fig. 1).3
Brighton & Hove
According to the three different lines of transfer of this Network, Brighton has identified specific policy challenges, briefly summarized below.
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1. Healthy City Profile e the GIS mapping Mapping the distribution of older people and matching the population with provision of services will enable analysis of service accessibility and identification of gaps and overlaps in provision. This will improve future commissioning. The city council is data rich but information is in different places and based on different data sources. Hence, there is limited use of GIS currently. The City is working towards being a WHO Age Friendly City, but political and senior management commitment is low. Older people are seen as dependent –and a drain on public services – not as a resource.
2. Vancouver Protocol The local NHS and Brighton & Hove City Council (BHCC) both fund ‘gateway’ organisations to ensure older user voices inform decision making, including BME elders. There are many older people user-led organisations /groups. The voice of older people is also evidenced in the Place Survey and Brighton & Hove Age UK/Brighton University Wellbeing research published in 2012, “Well-being in old age: findings from participatory research”. However this research was small-scale and we would like to involve a wider range of ‘voices’, using an evidence based methodology. The Vancouver protocol is an evidence based research methodology for running focus groups. It will help us to gather the qualitative information needed to inform our Healthy Ageing Profile.
3. Preventative activities to remain elderly people mentally and physically active in later ages Many of the services delivered to, for and with older people in the city are rather traditional. Brighton wish to learning and transfer good practice from other cities. New services and strategies have also undertaken Equality Impact Assessment in order to provide excluded groups with adequate support. Taking part in this Urbact Transfer Network is expected to favour learning from the best practice of Udine and other European partners as a mayor way to add value to the process of designing an action plan to improve the age friendliness of the city and make the city more attractive and socially cohesive.
Political and strategic context Brighton & Hove became and Age-Friendly City on 5 April 2013. A decision supported by all political parties in the Council. The participation into this Urbact Transfer Network represents a further step to building age friendliness and active ageing into Brighton & Hove city policies and so become a city fitting for all ages. The normative and strategic framework in which this project is rooted start from the National Health Service, that has branches at local level, to local action plans such as the City Plan, the Health and Wellbeing Strategy, the Adult Social Care Commissioning Prospectus. On these fields many groups, boards and stakeholders are working: eg., the B&H Clinical Commissioning Group, the Health and Wellbeing Board, the Local Strategic Partnership – family of partnerships, the local NGO “Community Works”. The motivation for being a partner city is to learn from best practice and to share our experience from Brighton & Hove. Being part of the programme will assist in the ongoing education and awareness raising of local stakeholders including Elected Members about the benefits of a preventative approach.
Implementation of the good practice at local level Many stakeholders are going to be engaged in the programme including Elected Members of the City Council and Senior Managers from statutory, voluntary and independent sector organisations. The Age Friendly City Steering Group (AFC) will provide the overarching steering group for the work. The AFC Steering Group will be a key monitoring group and will receive regular progress reports throughout the project. Committee Reports will also be produced. Project reporting to the Secretariat will take place in September 2014 and at the end of the project. Annie Alexander, Public Health Programme Manager, Brighton & Hove City Council is the lead senior officer and local co-ordinator participating in the transfer network (fig. 2). Annie Alexander will lead the Public Health Team, with the support of the Local Support Group. Jane McDonald is a representative of the Brighton & Hove City Council. Brighton & Hove hopes to include as wide a range as possible of stakeholders in the study visits and
transfer activities to ensure the maximum benefit from being a partner is achieved.
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Fig. 2 – The Brighton & Hove and Edinburgh staff – Study Visit in Udine – 5-7 March 2014
working with older people, as well as Adult Social Care. Residents will be involved via the Older People’s Council, the Age Friendly City Forum and via the 3 Locality Activity Hubs. Brighton & Hove is also considering to transfer the practice of LOOP forums (Local Opportunities for Older People) recently established in Edinburgh, which bring together local organisations, with a role in developing innovative ways of identifying isolated older people. According to the different working lines of this project, the City of Brighton & Hove has already defined some specific aspects of the transfer process. A brief summary is shown below:
The local stakeholders to the project are the Age Friendly Steering group, made of: Annie Alexander, Public Health Programme Manager (Chair) Lizzie Ward, University of Brighton Mark Dunford, University of Brighton Caroline Ridley, Impact Initiatives Jane Macdonald, Adult Social Care Penny Morely, Older People’s Council Becky Woodiwiss, Public Health Team Sue Barton, Department of work and Pensions Tracy Maitland, The Fed Julie Stacey, Sports Development Team Jessica Sumner, Age UK Kathy Murphy, Alzheimers Society Sarah Tighe-Ford, Equalities Team Liz Whitehead, Fabrica & Arts Commission Fig. 3 – Partners at work – The Brighton & Hove Staff - Study Visit in Udine – 5-7 March 2014
The Age Friendly Steering group meets quarterly. Brighton & Hove has a lot of experience with multiagency partnerships, including EQUAL, WHO Healthy Cities, ESF etc. Co-production with older people will be managed via the Steering Group, which includes representation from the major NGOs in the city
1. Healthy City Profile e the GIS mapping The main objectives and expected results from the GIS mapping in Brighton concern the improvement of available information (possibly in an integrated way); making visible the political and strategic commitment; improvement of services better suited on older people needs. Brighton & Hove has already developed a GIS mapping system of services and opportunities for people in the City, but these information are not matched with those on population, and more specifically, with those on elderly population. Fig. 4 – The GIS Mapping in Brighton & Hove Study Visit in Udine – 5-7 March 2014
Brighton & Hove finds in the good practice of Udine new ideas that could be will be transferred. Specifically:
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GIS Mapping principles and techniques – apply to local context ◦ Mapping of population data and services, such as: - Physical environment including bus stops, parks, shops; etc…) - Day activities for older people - Arts and culture - Health including pharmacies, GPs etc
Development of Healthy Ageing Profile ◦ Current and new data ◦ Consultation and survey
This work will help the City to develop its own Healthy Ageing profile including profiles of the localities; to involve community members as active participants in the process of building knowledge; to identify strengths and weak spots; to inform service delivery for the future. The development of a community profile including geographic, demographic, social and economic characteristics of the city will provide politicians but also services providers with useful information for decision making. The Health Profile will include data on: • location, size and topography of the district; • number and density of residents; • social, ethnic and economic characteristics; • numbers and proportion of older persons (60-74 and 75+); • housing type and tenure; • distribution of public, commercial and voluntary services.
Additional indicators eg., PH outcomes, Health Counts
Staff resource – PH Intelligence, existing staffing, AFC S/G, universities
Healthy Ageing Profile - June – September 2014, with the Profile ready for Older people’s Day in October
2. Vancouver Protocol Brighton & Hove is particularly interested in the implementation of the Vancouver Protocol even because in 2013 have joined the WHO Healthy Ageing Network it is fully engaged in the process of developing its own Age Friendly city profile. A healthy ageing approach, promoting independence and activity is an important ethos within many of our services.
Day Services for Older People have been redesigned into 3 ‘activity hubs’ from 1st April 2014, which offers potential for improved partnership working at locality level and offering a consistent range of services to older people across the city. This methodology encourages long term support and engagement by older people. For this reason the Steering Group has decided to undertake 5 Focus groups to explore what it is like to be an older person in the city (age and income will be used for the selection of participants). The focus groups will be also undertaken with carers. The possibility of conducting an online survey of people aged 65+ in the city will be also explored. The Local Co-ordinator of the project will ensure key deadlines are met; the attendance on study visit and transfer visits, producing reports, meetings of Local Support Group, and the communication activities requested by the project. Outputs that demonstrate the transfer will include: adoption of tools, techniques and ideas and verification of current practices. Outcomes that demonstrate the achieved results include: new approaches to engagement, informed understanding of what services to commission achieved from GIS work, informed understanding of what services to commission achieved from focus groups and surveys, improved partnership working between public and voluntary sector organisations, better engagement by politicians. Tangible examples will be recorded on how the learning has been applied and gain feedback from stakeholders to demonstrate impact. The main evaluation approach will be a self evaluation, based on the evaluation methodology being developed for the new Adult Social Care Commission for Day Activities. A combination of outputs and outcome measures will be used. Evaluation will be undertaken by the Project Team and led by the Local support Group. The work will be undertaken using the staff time of the Project Team.
Innovative capacity The most innovative aspects of this Transfer Network for Brighton & Hove rely on: 1. Implementation of an Age Friendly City approach; 2. Apply GIS/ Health Profiles principles and techniques to the local context; 3. Development of preventative services for older people – exchange ideas with other partners and apply these to developments
4.
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5.
6.
7.
underway in Brighton & Hove and to bring new ideas; Engagement with older people – all cities face the challenge of how to hear the voice of older people and how to ensure that this voice is a representative as possible exchange ideas with other partners and apply these locally represents a very innovative way of improve knowledge; Integration of Arts and Culture in citywide strategies for engagement and involvement of older people; Linking the Digital offer of the city – new technology /assistive technology – to address local issues, specifically around independence of older people; Political buy-in to issues of ageing.
The project is about sharing innovative projects and approaches. Brighton & Hove wishes to develop further best practice in analysis and planning services, preventative services and engagement of older people. The city has a good track record and wide experience of innovation.
Funding The URBACT Healthy Ageing project has allocated €51,080 to Brighton & Hove. Staff time dedicated to the project work will be recorded and charged from the project budget where appropriate. The City is committed to providing the 30% match funding needed to take part in the pilot. The project will also benefit from related developments already underway which are funded from a variety of sources including mainstream budgets. Adult Social Care has recently refunded its support for Day Activities for Older People and Citywide Coordination. While the funding for this is fully allocated, there is the potential to steer the work programme to take account of lessons learned during the Urbact project. In addition, Public Health has a small budget for older peoples work. There is also a potential through the new 20142020 ESF programme, which is overseen regionally by the Local Enterprise Partnership, which has a proportion of its budget reserved for social inclusion projects. There is also the possibility that this will be cofinanced by Big Lottery funding. Projects on social inclusion are likely also to be eligible through the Interreg IVA Two Seas Programme and the
Interreg IVA Channel Programme for which Brighton & Hove is in the eligible area.
Success factors and lessons learned The challenges faced by Brighton & Hove mirror those faced by Udine and other partner cities. Therefore the success factors that Udine is working towards (ie increasing healthy life expectancy, reducing social isolation and supporting older people to live independently in the community) are relevant to Brighton & Hove and other cities. Even if Brighton is part of well established networks, services and strategies there is still a too low commitment at political level on the healthy ageing issue. Anyway, the coordinator of the project is working to raise the interest of decision makers, public managers and politicians on this Project. In fact, Brighton is keen to partner Udine in its work to raise awareness of demographic ageing and promote opportunities for older people to remain physically, mentally and socially active as long as possible. Brighton has also experienced in previous years plenty of pilot and community initiatives that will contribute to the success of the transfer. As an example, it has participate into the Joint Strategic Needs Assessment 2013; into the Age Friendly City Assessment, using WHO framework; into the Wellbeing in Old Age – report of local participatory research undertaken by Age UK Brighton & Hove and Brighton University. An Annual Report of the Director of Public Health, 2010 (Resilience) has been published. Brighton & Hove will apply learning from Udine and other cities, taking account of the local context. This will include ‘lessons learned’, and knowledge and practice transfer. The Local Support Group will be involved in considering whether the challenges and issues faced by Udine apply to the local context and identifying how to apply them locally.
Transfer conditions There may be areas where implementation is easier in Brighton & Hove (for example, senior manager support for ‘prevention’ is well established) but also areas where additional challenges are faced (for example political and cultural aspects)
With respect to the transfer of the practice concerning the City Health Profile and the GIS, the following steps will be undertaken:
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1. adoption of the WHO methodology (Guidance for producing local Health Profiles); 2. check of the feasibility of building the 22 indicators in the WHO list; 3. identification of new indicators best suited for the specific knowledge needs of Brighton; 4. check of the feasibility to map elderly population distribution on the territory of Brighton; 5. check of new data availability and review of new data sources at the local level. Brighton, differently from other cities (Edinburgh and Grand Poitiers) has already developed a GIS mapping of services offered by the territory. Anyway, local stakeholder could have interest in mapping also other services within a GIS more focused on older people needs; 6. involvement of the Statistical Office of the Municipality or of other expertise from University; 7. consultancy with the staff of the University of Udine to plan data organisation for building maps (Prof. Fornasin of the University of Udine); 8. production of both population and WHO indicators for matching information by mapping; 9. Reporting 10. Assessment by Udine staff and Lead Expert Brighton is also interested in the Vancouver Protocol for both gathering qualitative information needed to complete the Healthy Ageing Profile and promote active citizenship and active ageing among older people.
Edinburgh: Mapping “the life in your years” 24
The local context and the policy challenges The City of Edinburgh Council (UK) has a population of 482,640 (source: GRO projection 2012) living in a boundary which covers 264km2.
Over the next 20 years, large increases are expected in Edinburgh in the number of people in each of the following older persons age groups: 65-74, 75-84 and 85+ (fig. 1). In particular, the number of persons in the 85+ age group is expected to almost double by 2032, moving from the present number of 11,040 in 2012, to 19,294. In contrast, the traditional working age population will remain comparatively steady, increasing by only about 15%, which will have an impact on funding available through income tax. The main areas of intervention included in the agenda of the Municipality of Edinburgh are the following: 1. shifting the balance of care 2. reducing social isolation 3. increasing healthy life expectancy
Like many other cities in Europe, Edinburgh faces policy challenges related to demographic change. Whilst demographic change presents challenges for health and social care services, it also offers many opportunities. Advances in health care and healthier lifestyles mean that people are living longer generally and almost 90% of people over 65 years are not in the care system at all. The growing number of older people, many of whom are increasingly fit and active until much later in life, can be regarded as a significant resource, with a great contribution to make to society. However, with increasing age there is also an increase in the number of people living with longterm conditions, disabilities and complex needs. The Scottish Government has indicated that one in three people over the age of 75 years will have two or more long term conditions. Fig. 1 – Edinburgh’s changing population
1. Shifting the balance of care In order to achieve the aim of the national “Reshaping Care for Older People” strategy, to optimise the independence and wellbeing of older people at home or in a homely setting, a shift in the focus of care from institutional settings to care provided at home is required. Significant progress has been made in Edinburgh to achieve this shift in the balance of care. The percentage of older people with high level needs who are cared for at home has increased from 14% in 2002 to 30% in 2012. This result has been reached through investment in community based services and by changing the way that services are provided to benefit more older people. The target for 2018 is to have a balance of care of 40%.
2. Reducing social isolation Research demonstrates that loneliness has a significant effect on mortality. Evidence suggests that the impact of loneliness on health and wellbeing is significant, with links to increased blood pressure, depression and a 50% decreased likelihood of survival for older adults without significant social relationships, which is comparable with well-established risk factors for mortality such as smoking and obesity. A study from the University of Chicago found lonely individuals are more than twice as likely to develop symptoms of Alzheimer’s disease as those who are not lonely (Windle, K, Francis, J, Coomber, C. Preventing loneliness and social isolation: interventions and
outcomes, Social Care Institute for Excellence, 2011)
3. Increasing healthy life expectancy
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With growing numbers of older people, more of whom are living in the community, the policy challenge is to extend the healthy life expectancy, to support older people to live independent, active and good quality lives for as long as possible. This policy challenge is reflected in the WHO Active ageing framework. Udine has experience in analysis and planning services and activities for older people and this is relevant to transfer to Edinburgh. Udine has developed good practice in i) data analysis and GIS mapping; ii) preventative services for older people; iii) consultation and engagement with older people, which can be shared. Edinburgh has shown through recent work on the Change Fund for Older People and its engagement in the UK Age-Friendly Cities Network and other examples, that it wants to learn from other cities and apply learning to how services for older people are planned, developed and delivered. Edinburgh is particularly interested in transferring the following aspects along the three main lines of action of the network: 1. GIS/ City Health Profiles – Edinburgh wishes to apply principles and techniques to the local context, and especially:
Mapping of population data and services e.g. homecare, day services for older people; New developments in mapping existing dementia services, informing about new dementia services e.g. location of dementia cafes; Additional indicators such as the use of health and social care services;
2. Preventative services for older people – the city wishes to exchange ideas with other partners and apply these to developments underway in Edinburgh and to bring new ideas. An example from Udine that could be transferred includes a focus on mental agility and cognitive skills within public community settings; 3. Engagement with older people – Edinburgh has examples to share with other cities of how it has successfully engaged older people in the planning of services. All cities face the challenge of how to hear the voice of
older people and how to ensure that this voice is as representative as possible. To address these objectives the city partners have set up a Local Support Group made of a wide number of stakeholders including older people and carers representatives, volunteering organizations, private sector care agencies, Health and social Care Committee, Housing Committee, National Health Service and ED leisure representatives. In setting up the LSG, Edinburgh has also taken into account the mainstreaming of gender equality and non discrimination. In fact, Edinburgh has innovative practice supporting Lesbian, Gay, Bisexual and Transgender (LGBT) and Black and Minority Ethnic (BME) communities which can be shared. The Local Support Group represents interests from different equality groups. An
Equality and Rights Impact Assessment was undertaken as part of the development of ‘Live Well in Later Life’ Edinburgh’s Joint Commissioning Plan for Older People. Edinburgh is also going to host the second Transnational Thematic Exchange Meeting that will be jointly organized with Brighton & Hove in the first week of October 2014. Anyway, wider learning and transfer will continue, aligned to the action plan for the joint Commissioning Strategy 2012-22. Edinburgh is currently working on a 3 year action plan (201215), for the 10 year strategy.
Political and strategic context There are two main strategies at national level relevant for the transfer of the practice of Udine in Edinburgh: 1. the national strategy for older people named
Reshaping Care for Older People (2011-21) which aim is to support older people to live independently at home/ in a homely setting; 2. the strategy for shaping local service developments in Edinburgh named
Scotland’s National Dementia Strategy (2013-16). These strategies are accompanied at local level by a key local programme named Live Well in
Later Life, Edinburgh’s Joint Commissioning Plan for Older People 2012-22. The vision of this strategy has been developed in consultation with older people, and is summarized in the following statements:
“In Edinburgh, we value older people and respect their dignity. Our vision is that older people:
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feel safe, feel equal and are supported to be as independent as possible for as long as possible
can participate communities
are involved in the development of services
can access and receive quality care and support that takes account of their needs and preferences.”
in
and
contribute
to
their
Edinburgh has actively promoted the interests of older people across all aspects of city life for many years, through the ‘A City for All Ages’ programme.
actions to progress the work. A Local Support Group has been established including older people and equalities groups. The diagram in fig. 3 shows an outline structure for governance, reporting and communication for the project. This builds on existing groups, structures and existing channels. New developments that are already underway to engage older people and other key stakeholders, for example forums, newsletters, web content, media/ social media etc. will be utilised. Fig. 3 – Diagram on the model of governance of the project adopted by Edinburgh
Implementation of the good practice at local level The motivation of Edinburgh for being a partner city within this Urbact Transfer Network is to learn from good practice and to share experience with other cities. Being part of the programme will assist in the ongoing education and awareness raising of local stakeholders about the benefits of a preventative approach. At this aim, as already pointed out above, many stakeholders have been involved and others will be engaged in the programme including Elected Members of the City Council and Senior Managers from statutory, voluntary and independent sector organisations. The Edinburgh Joint Older People’s Management Group will provide the overarching steering group for the work. Tricia Campbell, Senior Manager for Older People will be the lead senior officer participating in the transfer network (fig. 2). Caroline Clark, Planning and Commissioning Officer for Older People’s Services will be the Local Co-ordinator (fig. 2). Fig. 2 – Edinburgh and Brighton & Hove staff – Study visit in Udine – 5-7 March 2014
There is a lot of experience of multi-stakeholder groups and partnership working in Edinburgh. Examples include: Live Well in Later Life, which is a joint plan between 4 partners. The Change Fund has involved 4 partner sectors (NHS, Council, voluntary and independent sectors). A Checkpoint Group has been established for areas of policy change/development, involving older people and interest groups. The “A City for All Ages Advisory Group” is a long standing older people’s forum which aims to ensure the voice of older people and it is heard in a wide range of policy areas. Co-production is an approach being explored and developed in Edinburgh – a new outcomes focused assessment tool aims to develop in partnership with the service user innovative ways to meet their goals. This will be implemented in line with the new legislation for ‘Self-Directed Support’ from April 2014.
As a matter of fact, the active ageing issue is clearly a key point in policy planning in Edinburgh.
A Project Team made up of key members including Older People’s Services, Research & Information, voluntary/ independent sector and communications officers will plan and deliver the
In fact, many projects and programmes are already ongoing at local level. A study to analyse and assess the needs of older population has already been undertaken as part of the “Live Well in Later Life Programme”. Moreover, Edinburgh has recently implemented a programme of projects as part of the national “Change Fund for Older People”. Part of this included the establishment of an “Innovation
27
Fund” for voluntary sector organisations to deliver innovative community based services and activities for older people. A healthy ageing approach, promoting independence and activity is an important ethos within many of our services. For example, ‘Reablement’ is an approach which focuses on supporting people to do things for themselves, rather than a traditional approach of many services which did things for people. Homecare services in Edinburgh were transformed from 2008 to be built around the Re-ablement approach and it is now being developed within “Day Services for Older People”. Work is underway in Edinburgh to develop a dementia friendly city. This provides an opportunity to engage with the business community, retailers and organisations we have had little engagement with previously. LOOP forums (Local Opportunities for Older People) have recently been established, which bring together local organisations, with a role in developing innovative ways of identifying isolated older people.
Anyway, how analyse data, using GIS mapping and other tools to inform service planning, is something that has not yet been applied in Edinburgh and that the City would like to transfer.
The Local Co-ordinator will ensure key deadlines are met. Staff time dedicated to the project work will be recorded and charged from the project budget where appropriate. The steering group will consider further options for example, the recruitment of an intern with specialism in GIS, employed for 3 months to produce the maps. To guarantee the transfer of the good practice of Udine, in particular with respect to the GIS system on population/services mapping, political support is in place for the “Live Well in Later Life plan”, aimed at the promotion of independence, healthy ageing and prevention. The Councillor Ricky Henderson, Convenor of the Health, Social Care and Housing Committee will be the key political link for the Healthy Ageing project. An initial Committee report about Edinburgh’s involvement in the project was agreed in January 2014. The JOPMG will be a key monitoring group and will receive regular progress reports throughout the project. Committee Reports will also be produced. Project reporting to the Secretariat will take place in September 2014 and at the end of the project. The Project Team will also produce a “project diary”
that will record all the activities developed at city level. The project diary will be a useful tool for sharing with other cities partner progresses in transfer, problems, obstacles encountered and possible solutions. The Project Team of Edinburgh will include members of the Change Fund Evaluation Group. Their role concerns the monitoring and evaluation of Change Fund projects and the Healthy Ageing project will be added to their remit/agendas. They will provide information for consideration by the Local Support Group and the Joint Older People’s Management Group. Project outputs will include attendance on study visit and transfer visits, producing reports on meetings of Local Support Group, communication activities and outputs. Outputs demonstrating the transfer of the GIS in Edinburgh will include the adoption of tools, techniques and ideas based on the Guidance for producing local Health Profiles of older people as well as on the advices of the staff of the University of Udine that has developed the model. Outcomes of the achieved results will include new approaches to engagement, informed understanding of what services to commission achieved from GIS work. Edinburgh will record tangible examples of how the learning has been applied and gain feedback from stakeholders to demonstrate impact. Self evaluation will be the main evaluation approach, based on the Evaluation Framework used to evaluate the Change Fund programme. This includes a combination of outputs and outcome measures, and this will be undertaken by the Project Team and led by the Steering Group. The work will be undertaken using the staff time of the Project Team.
Innovative capacity The project is about sharing innovative practices and approaches. Edinburgh wishes to develop further good practice in analysis and
planning services, preventative services and engagement of older people. Edinburgh is keen to promote innovation as is demonstrated through recent Innovation Funds being made available. The City Council has recently launched the BOLD (Better Outcomes, Leaner Delivery) programme, to promote innovative, new ways of working within the context of financial constraints. Edinburgh also recently applied to the Mayor’s Challenge, with an
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innovative proposal developed in partnership with Edinburgh University. Edinburgh is keen to learn from good practice of other cities. In fact, it was the first area in Scotland to develop the Re-ablement Service, based on best practice from other parts of the UK. Edinburgh was also a national pilot site for implementing the Integrated Resource Framework, which aims to help NHS and Council partners to better understand how resources are used.
Funding €49,080 have been allocated to Edinburgh from the URBACT Healthy Ageing project. The project will also benefit from related developments already underway which are funded from a variety of sources including the Change Fund and mainstream budgets. The budget for older people’s health and social care services in Edinburgh is around £217m per year. The Change Fund has provided an additional £8m per year to support shift in balance of care and promotion of prevention.
Success factors and lessons learned Most of the challenges faced by Edinburgh are shared by Udine and other partner cities participating in this Network. Therefore the objectives that Udine is working towards are relevant to Edinburgh and other cities: e.g. the efforts aimed at increasing healthy life expectancy, reducing social isolation and supporting older people to live independently in the community. With respect to the success factors identified in the good practice of Udine, Edinburgh is in a very favourable condition. It comes into evidence that in Edinburgh there is a strong commitment on the healthy ageing issue at political level as many Elected Members of the City Council and Senior Managers from statutory, voluntary and independent sector organisations are effective members of the Steering group meeting of the project. This fact meets the first success factor of the transfer shown at pag. 11. The second factor of success is met, too. In fact, as shown above, Edinburgh has well established networks, services and strategies in place to support the experience of transfer of the good practice of Udine, including the “A City for All Ages” and the “Live Well in Later Life” strategies. The City is also part of the WHO network on “Age-Friendly
Cities” and, more in general, has a wide experience of European projects. Hence, Edinburgh is keen to partner Udine in its work to raise awareness of demographic ageing and promote opportunities for older people to remain physically, mentally and socially active as long as possible. Edinburgh is also strongly committed on investing in preventative approaches in order to improve health and well being and delay the need for older people to access higher levels of care. The numerous activities and services offered to elderly people in Edinburgh show that the model of governance
is strongly oriented to an integrated approach. The “Get Up & Go Guide to What’s on in Edinburgh” is a clear example of how Councillors of different Departments can actually and effectively work together. The activities provided offer encouragement to lead a more active and healthy lifestyle and include: allotment programmes, cycle skills and bike loan, walking, buddy swim and gym, dancing, seated exercises, new age indoor kurling, photography & knitting, singing etc… Edinburgh will apply learning from Udine and other cities, taking account of the local context. The Local Support Group will be involved in considering whether the challenges and issues faced by Udine apply to the local context.
Transfer conditions There may be areas where implementation is easier in Edinburgh (for example, political and senior manager support for ‘prevention’ is well established in Edinburgh) but also areas where additional challenges are faced (for example the weather, food and cultural aspects in Edinburgh need to be considered as they differ from the Udine experience). With respect to the transfer of the practice concerning the City Health Profile and the GIS the following steps will be run: 11. adoption of the WHO methodology (Guidance for producing local Health Profiles); 12. check of the feasibility of building the 22 indicators in the WHO list; 13. check of the feasibility to map elderly population distribution on the territory of Edinburgh; 14. check of data availability and review of data sources at the local level;
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15. involvement of the Statistical Office of the Municipality or of other expertise from University; 16. consultancy with the staff of the University of Udine to plan data organisation for building maps; 17. production of both population and WHO indicators for matching information by mapping; 18. Reporting 19. Assessment by Udine staff and Lead Expert Anyway, Edinburgh is also interested in strengthening actions engaging elderly people in the planning of services, voicing their needs and suggestions on possible solutions to daily life difficulties. Fig. 3 - Edinburgh staff at the Kick-off meeting in Paris – 29-31 January 2014
Partners at work – Study visit in Udine 5-7 March 2014
Working groups – Study visit in Udine – 5-7 March 2014
Grand-Poitiers: towards an intergenerational approach 30
The local context and the policy challenges Grand Poitiers counts 142,537 inhabitants. It is an association of 13 metropolitan areas. Poitiers is the main city of this urban community with 90,625 inhabitants (fig. 1). Fig. 1 - The Urban community of Grand Poitiers – the 13 municipalities
In Gran Poitiers, nearly 15% of the population is aged more than 65, which is almost the national average. However, it is worthwhile noting that nearly 60% of the population aged 65 and over is aged 75+ years. At the same time, Poitiers shows the strongest rate of 15-29 years people within the cities of more than 50,000 inhabitants (demographic data of 2006). According to these data, Grand Poitiers has started working on promoting and supporting intergenerational actions on its territory since 2008. The overall philosophy driving these actions was to enhance the wellbeing at all ages through innovative ideas for “living together”. Hence, the relationships between generations represent a question of particular concern for the decision makers of Grand Poitiers. The city is currently facing at this issue under the joint impulse of the Council for Sustainable Development (Conseil de Développement Responsable) and the Agency of Times (“Agence des Temps”), which are working along the following three main lines of action: 1. associative life and intergenerational approach 2. housing and life environment 3. citizens involvement in intergenerational projects
The main problem is that these lines of action should be more integrated one each other, in order to create a more stable local policy in this field. The task is not easy, because actions are developed looking at single sectors of intervention following a “silo” model where each actor invests financial resources in activities impacting single lines of action. Hence, the advantages that could come from a more integrated and
intersectoral model of action and planning are inevitably lost. Healthy Ageing concerns various domains like outdoor space & buildings, housing, employment, civil participation, communication and information, transportation, social participation, community support and health services etc… Numerous activities and a huge debate is ongoing on these areas of action in Grand Poitiers. Anyway, activities and new ideas seem to remain isolated experiences. Much more effort should be done to integrate these lines of intervention to develop a more integrated strategy of action. Even the local community should be more committed on supporting active ageing for strengthening social cohesion. The participation of Grand Poitiers in the Urbact Network on Healthy Ageing will enhance the experience of the city in the field of participative processes. At the same time, the support coming from the use of new tools for profiling the elderly population and their needs will improve the capacity of the Municipality to generate public interventions effectively based on the comprehension of older people needs. This is a challenge that the representatives who will win the elections of next March 2014 will have to face at. The recent involvement of Grand Poitiers in the European URBACT Transfer Network on “ Healthy Ageing” (support to active ageing) led by Udine (Italy– lead partner), in partnership with Edinburgh, Brighton & Hove (UK) and Klaipeda (Lithuany), should help creating a necessary public and integrated model of policy making, that numerous local actors are ready to enhance.
Political and strategic context At national level a really ambitious Alzheimer Plan has been launched to better understand, better diagnose and better manage the disease.
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Over a period of five years (2008-2012), it represents a cumulative effort of 1.6 billion euros, financed by the state and by insurance including medical deductibles. In September 2013, the government launched works to develop the new plan of "neurodegenerative diseases". On the issue of Ageing there is not a national strategy: the topic is pretty new. The Prime Minister has launched the preliminary consultations in the development of the law on the adaptation of the ageing society, which should be voted in late 2014. At the local level, in Grand Poitiers, there is not yet a plan. The City can count on the current assistance system (only financial support to access home services) provided by the County council of Vienne (lost of autonomy).
However the municipal elections of March might allow the development of a stronger political support about intergenerational questions. Fig. 2 – Grand Poitiers staff – Kick off meeting in Paris – 29-31 January 2014
Implementation of the good practice at local level
Fig. 3 – Grand Poitiers staff – Study Visit in Udine – 5-7 March 2014
Within the wider framework of Intergenerational policy, Grand Poitiers aims at implementing tools that may allow the City government to generate public interventions more based on an effective comprehension of the needs of the elderly population. More in detail, there are two different levels of interest of Grand Poitiers in this transfer experience: -
The knowledge of new practices concerning
participative processes and elderly people profiling tools (Healthy Cities Profiles and GIS mapping); -
The implementation of a concrete public policy around the intergenerational approach as a core element of active ageing
The first step was to set up the Project staff to whom all actions are referred. Noëlle Billon is the key contact person at the local level to ensure that all necessary information is provided to both the lead partner and the managing authority (fig. 2). Mrs. Mireille Terny (site and communication manager) is in charge of the implementation of Time and Intergenerational policies actions in Poitiers, included the coordination of the stakeholders. Mr. Dominique Royoux is the Director of Prospective and Territorial cooperations Department and of the “Agence des Temps” (Agency of Times) of Grand Poitiers. He is also the supervisor of the “Conseil de Développement responsable” which is a consultative and participative instance (fig. 3). There is currently a strong political interest of the elective representatives in charge of the elderly policies in the Urbact Healthy Ageing Project. .
At the moment, the representative actors involved in the project are the following: a) The Sustainable Development Council (le CDR, Conseil de Développement Responsable)The Development Councils are citizen advisory councils that improve the reflection of elective representatives about what is at stake on the territory. Their composition and their functioning are free. In Grand Poitiers, the CDR is composed of different stakeholders: elective bodies, institutional bodies, associations, citizens. b) The Agency of Times (L’Agence des Temps) This structure is interested in rhythms of citizens’ life and keeping with those rhythms, the existing services on the territory. National agencies of Time are gathered together within the association Tempo territorial. The Agency is supported in its reflection and its actions by the group Grand Poitiers/Temps which is made of two elective representatives for each municipality within the urban area. Animation of the CDR and the Agency of Times is carried out within the unit Prospective and Territorial Cooperations Department of Grand Poitiers.
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The staff of the Project has also worked at setting up a Local Support Group that will accompany all the phases of transfer of the Project. The LSG members will be either in charge of implementation of the activities (self funding and inspirational/creative contributions) or recipients (eg.: the activity is “physically” implemented within their structure). The Prospective and Territorial Cooperations Department of Grand Poitiers who coordinates the Local Support Group is competent for implementing innovative political policies by animating in an integrated way different structures. The actors currently engaged in the LSG are: a) L’AFEV – Association Fédération des Etudiants pour la Ville An Association financed by the State. The aim is sustaining students in addressing concrete actions for the development of neighbourhoods; b) Le CCAS – Centre Communal d’action sociale It is a city centre whose action concerns three different sectors of intervention: early childhood, elderly people, and disabled persons; c)
Le Centre Socio-Culturel des 3 Cités (Neighbourhood house) and Le Local (Neighbourhood house) These social-cultural associations are financed by both the city of Poitiers and the Region. Their objective is to contribute to the harmonious development of the neighbourhoods.
d) Le réseau gérontologie Ville/Hôpital de Grand Poitiers (gerontology network of Grand Poitiers hospital and the city) The network facilitates the entire, individual and multidisciplinary care of older persons who are more than 60 years old and who are in difficulty and need delicate medical and social assistance. The network does not replace the offer of treatment and other existing help services; it improves the efficiency, the orientation of the patient among the health disposals etc… e) SIPEA – Organisme Public de Logement It is the Local authority landlord of Poitiers, which currently adopta participative approach (“IHHS”) for the creation of a reference document with all the factors contributing to the wellbeing in a neighbourhood. Grand Poitiers can also rely on previous studies focused on the analysis of elderly people needs. In fact Grand Poitiers has established regular cooperation with academic students who
have contributed to carry out a number of surveys on the theme of intergenerational relationships, and particularly on two specific topics: -
intergenerational relationships in association and in the development of volunteering;
-
intergenerational cohabitation
Those surveys have enabled the definition of needs and the implementation of well focused actions: training sessions oriented to enhance intergenerational actions in associations and the creation of an intergenerational cohabitation service. Grand Poitiers is keen to use the survey methodology of collecting data to monitor the activities to be transferred within the Urbact Healthy Ageing Project. The activities that Grand Poitiers is going to transfer will be managed, monitored and assessed as follow: 1. City Health Profile and GIS mapping The LSG considers the City Health Maps a practice of particular interest for the policy making at local level. City Health Maps represent a great opportunity to know in a more detailed way the local context in order to lead targeted actions. Healthy maps could allow policy makers and stakeholders knowing better the local context: the geographical context in which elderly people live; the location of existing services on the territory in different domains: housing, social life, services, public spaces. The linkage between these two main informative streams can offer the City a high added value in decision making. The implementation of the Health City Maps is also linked to a work currently led on the territory of Grand Poitiers: the creation of a reference document that allows defining the adapted environment to ageing of the elderly. Those maps can effectively help the planning of, and the decision on, other actions. The following questions will be taken into account during all the process of transfer of the practice: What data are needed for the implementation of the WHO indicators as well as for the maps’ building? Are they available? Who can provide data? (check list and review of the data sources) Which data are relevant to be crossed with respect to the case of Grand Poitiers? At the moment, the LSG has identified the following areas of collecting data for mapping: older people distribution; transport services; social care organisms and associations.
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A number of map to be built will be agreed within the LSG according to the prior needs of the City. The team is expecting that, starting from a better knowledge of the territory, policy makers will be able to provide public services which correspond better to the life of older people in order to promote a really Age-Friendly Healthy city.
2. Vancouver Protocol Grand Poitiers is very interested in transferring the methodology of the Vancouver Protocol. This methodology would help the City to improving knowledge on needs, problems, obstacles to daily life of elderly people and collecting suggestions on more effective interventions to be run at local level. At the same time the involvement of elderly people and other stakeholders favour active participation in community life, sustaining both social cohesion and trust towards institutions.
Get older people involved in the community life make the City much more Age-friendly and this is the added value of this good practice. Grand Poitiers, following the Age Friendly Cities Guide as well as the experience reported by Udine during the Study Visit (5-7 March), Grand Poitiers will set up the “focus groups” engaging, at the beginning, elderly people (4 Focus Groups) and older people houses Associations (1 focus group). Grand Poitiers will be engaged in involving about 100 people in this activity. Another effort will be done to identify, according to the criteria suggested by WHO methodology (age and income), those participants that will suite at best the characteristics required. The assessment of this activity will follow two routes: on the one side, the LE and some external experts of the staff of Udine will use the method suggested by the WHO protocol; on the other side, a social housing organization (member of the LSG in Grand Poitiers) will carry out a survey in 2 neighbourhoods of Poitiers to assess the relevance of the indicators issued by the protocol of Vancouver for the older people and professionals engaged in the focus groups.
3. Preventative actions - Projects to remain mentally and physically active – It would be useful to replicate at local level the good practice of “Move your minds…minds on the move” that has seen the cooperation between the University of Udine, the University of the Third Age and a number of professionals, associations and so on. Grand Poitier, starting from the good practice of Udine, is thinking about the creation of
a “Université Inter-âges” in domains like sports. To improve the social inclusion of elderly people, keep them active, mentally as well as physically healthy, a partnership between the Sports service of Grand Poitiers and some social care organisms and associations (CCAS) could be built. The number of people to involve has not been yet defined but the LSG has planned to reach at least 50 people in the first programme session. In order to monitor and evaluate the satisfaction of participants in this project, a satisfaction survey will be carried out using the pre and post test questionnaire already tested by Udine. These tools represent a template that Grand Poitiers will be free to adapt to the specific contents of the courses and services offered within the project.
Innovative capacity The Prospective and Territorial Cooperation Department has already started the implementation of Innovative practices in the field of Time and intergenerational policies. The main questions that the good practice of Udine could help the City to cope with, concern the following points: -
How to reach elderly people and engage them in giving a contribute to community life?
-
How to make elderly people knowledge and know-how visible and available for transfer to other generations? The idea of Grand Poitiers is to put into action elderly people
experience as a resource for young generations. -
How to build a local active ageing public policy rooted in a stable and sound cooperation with a number of local stakeholders? The main idea is willing to make the LSG sustainable
beyond the URBACT project.
Funding The activities that the stakeholders of the LSG will carried out within this project will be self-funded. According to the provisional version of the FEDER regional programme 2014-2020, this project could apply for EU funds regarding the following lines of action: Axis 2. Specific Objectives: increase the accessibility to services of sustainable and clean mobility. In this sense, the “accessibility of train
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stations by persons of reduced mobility, in a context of an ageing population” could be supported
3. Preventative actions - Projects to remain mentally and physically active –
Axis 3: Specific objective 2c.1: “Improve the accessibility of services to the public by numeric tools”. The actions financed will be on the following domains: - e-health (e-medicine, e-supervision, etc) - for the ageing population and/or persons in a situation of disability; support to digital projects enabling to improve their life conditions at home, development of health information systems.
Grand Poitiers has already identified some relevant aspects
Success factors and lessons learned Differently from Edinburgh and Brighton & Hove, Grand Poitiers is less robust with respect to the success factors evidenced by Udine. In Grand Poitiers we cannot count on the current political will because elections are forthcoming and a shift in the political governance of the City could put an obstacle to the Healthy Ageing Project transfer; the City is not currently involved in any international network and it has less experience in managing European project with respect to the other partners; an integrated model of governance is not adopted, and this limit represents one of the most challenging factors put into evidence by the staff of Grand Poitiers. The last point, the one concerning the participative and deliberative process adopted by Udine to involve elderly people, represents one of the results expected by Grand Poitiers from this transfer experience. Anyway, there are some specific strength points that will enable Grand Poitiers in reaching the expected results within each line of action. Here below some success factors on which Grand Poitiers can count on along each line of action:
Transfer conditions With respect to the transfer of the practice concerning the City Health Profile and the GIS the following steps will be run: 1. 2. 3.
4. 5.
6.
7. 8. 9.
With respect to the transfer of the Vancouver Protocol methodology the steps to be followed are shown below: 1.
1. City Health Profile and GIS mapping favourable exchanges of data and information among stakeholders. The cooperation with public managers and the presence in the staff of professionals with expertise on GIS will make easier for the City partners to select information effectively neede for creating mapping; 2. Vancouver Protocol Grand Poitiers is strongly committed on bottom-up processes and this could a strength point to succeed in the transfer of the Vancouver Protocol;
adoption of the WHO methodology (Guidance for producing local Health Profiles); check of the feasibility of building the 22 indicators in the WHO list; check of the feasibility to map elderly population distribution on the territory of Gran Poitiers; check of data availability and review of data sources at the local level; involvement of the expert that the staff of Grand Poitiers has already identified as key actor of this transfer action. In fact, Grand Poitiers has the know-how needed for the realization of the GIS mapping; consultancy with the staff of the University of Udine to plan data organisation for building maps; production of both population and WHO indicators for matching information by mapping; Reporting Assessment by Udine staff and Lead Expert
2.
3. 4. 5. 6.
adoption of the WHO methodology (Age Friendly City Guide) accompanied by the Udine Report on “The health profile of elderly people in Udine”; building groups engaging the LSG members in finding out how to get elderly people involved. Grand Poitiers has also planned to use local media, social care workers and the “Ville hôpital network”, a geriatric care network, etc…; identification of volunteers with the expertise needed for the conduction of the focus groups; conduction of the focus groups; reporting activities according to the standard fixed by WHO; assessment of the work done on the basis of the guidelines indicated by the Who guide.
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According to the third line of intervention focused on preventative actions aimed at enable elderly people to remain mentally and physically active, the steps that Grand Poitiers has agreed to follow are described below: 1
2
3 4 5
6
involvement of a number of actors motivated to accompany the implementation of the action as teachers or trainers (students in advanced degree in Nursery, public hospitals, sport services, municipal centre of social actions, local association networks, etc…); dissemination of the initiative at local level in order to collect elderly people interested in attending labs/activities (older people houses, general practitioners, chemists, etc…); selection of topics or specific activities to implement; planning the programme of labs/activities; start of the activities programme and submission of the pre-test questionnaire to participants; at the end of the programme submission of the post-test questionnaire to participants.
Grand Poitiers staff – Study Visit in Udine – 5-7 March 2014
Grand Poitiers Working group - Study Visit in Udine – 5-7 March 2014
Grand Poitiers and the other representatives of the Network - Study Visit in Udine – 5-7 March 2014
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Klaipeda: embedding actions in a wide healthy ageing strategy The local context and the policy challenges The City of Klaipeda (LT) has a population of 158,541 (2013) inhabitants living in a boundary which covers 98km2. Fig. 1 – The map of Lithuania and the City of Klaipeda
Collaboration among different sectors of policy is limited and an effective understanding between decision makers and elderly people is still lacking. Age Friendly Cities principle are differently interpreted among groups and sustained by a variety of motivations. Difficulties are also encountered in collaboration among health, sport and NGOs engaged in active ageing activities. Participation of elderly people in activities is limited for different reasons. Anyway, it seems quite easy to motivate politicians and specialists to integrate and implement new activities at the local level as well as to create a common Age–Friendly City strategy and integrate activities into a common plan of interventions in Klaipeda. The good practice of Udine shows that it works and is effective. The transfer project will help to motivate: a) politicians to implement a new active ageing strategy; b) specialists and professionals to work more actively with new activities; c) elderly people to participate in new activities.
In Klaipeda elderly people aged 60 years and over are 23.7% of total population. Given the demographic trends of the City, as well as throughout Lithuania and Europe, the number of elderly people raise while, according to health monitoring indicators, quality of life decline. By studying the tools and instruments put in place by Udine in order to cope with these trends Klaipeda hopes being able to provide elderly population with new and more tailor-made services. In Klaipeda a variety of wellness activities and programmes is designed to involve a higher proportion of individuals belonging to this target group. Still initiatives aiming at ensuring a healthy life to elderly people are scattered and not embedded in a wide strategy. For this to happen there is a need for an in depth analysis of the target population and the services available and their distribution. Political commitment is currently very low and there is a huge gap between theory and practice.
An increased political attention to a Healthy Ageing strategy could foster new innovative and more accessible activities adapted to Klaipeda context; improve relationships among sectors in the process of healthy ageing decision making.
Political and strategic context At the moment, Lithuania is implementing a state programme, coordinated by the Lithuanian Ministry of Social Security and Labour. In the beginning of the 2014-2020 period, the regional development plan provides for the inclusion of older people in health preservation and promotion programs. Klaipeda has established at City level a Public Health Bureau active in senior health promotion. Its qualified staff is currently in charge of implementing the Healthy Ageing project activities. The Municipality has also a Health care Department entitled for managing the Strategic Development Plan of Klaipeda city 2020. The plan is available at the following link:
http://www.klaipeda.lt/eng/The-strategicplan/2496.
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The priorities of the City Plan concerns a) a healthy, bright and safe community; b) a sustainable urban development; c) the improvement of the competitiveness of the city. The preparation of Klaipeda City Strategic development plan 2013-2020 has taken a year and a half. A lot of community people have participated in its preparation. Five working groups for preparation of the strategic plan were established in the following fields: Social Care, Health Care and Security Affairs; Education, Culture, Sports and Youth Affairs; Business and Tourism; Spatial Planning, Environment and Ecology; General Management of Public Services. Members of the working groups were politicians, civil servants, representatives from budgetary institutions (schools, social care, culture and sports institutions, hospitals and other) representatives of universities and colleges, trade unions, business organisations, NGO‘s. A strategic monitoring system of Klaipėda City Strategic Development Plan 2013-2020 has been foreseen. It consists of two parts: methodology advices on data collection; a list of key performance indicators. The review of key performance indicators is presented to the City Council and society. Some initiative programmes are ongoing: eg., physical activities (Nordic walking, gym, sport activities), Third age university, a community health board, etc… Finally a Health programme for quality updating at city level has been defined.
Implementation of the good practice at local level Klaipeda has a strong will in implementing most of the good practice of Udine: the City Health Profile and the GIS mapping system; the Vancouver Protocol; the active ageing projects to remain physically ad mentally active. At this aim the City has set up the project team made up of employees and local supportive group (9 persons). Every person has individual role in the project transfer process. One person is going to be employed for a period of 14 months (financial officer). The staff of the city is made of Jurate Grubliauskiene, member of the Public Health Bureau of Klaipeda, Local coordinator of the the Project; and Natalja Istomina, professor in the Faculty of Health Sciences of Klaipeda University, Member of Klaipeda city municipality Council, Chair of Health Care Commission (fig. 2). There are also a number of elective members directly involved in the Project as Klaipeda
municipality is a main beneficiary from the transfer of the good practice of Udine with the most impact on the quality of life of elderly. Fig. 2 – The staff of Klaipeda – Study Visit in Udine – 5-7 March 2014
Hence, the elective members involved in the activity of the LSG are:
the Mayor of Klaipeda city; the Head of the Department for City Strategy Planning and Implementation; the Head of Health Care Department the Director of Public Health Bureau. He also plays a role of project coordinator at the local level.
The stakeholders of the LSG varies with respect to the different lines of intervention. Hence, the LSG working on the City Health Profile and the GIS mapping transfer, is made of:
General Practitioners Public Health specialists Social workers Municipality staff University staff Small and medium size companies
That one working on the Vancouver Protocol transfer, is made of:
Urban plannig specialists Transport specialists Public Health specialists Municipality staff University staff
Finally, the LSG working on the implementation of preventative services aiming at enabling elderly people to remain mentally and physically active in later ages, is made of:
Public Health specialists Municipality staff University staff
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Sport specialists Sport and social institutions
Fig. 3 – Working groups and the staff of Klaipeda Study Visit in Udine – 5-7 March 2014
In fact, the production of Healthy Ageing maps is included into national and local documents. Hence political support to mapping idea does exist. GIS systems have been already implemented in different sectors of action at the local level. But, until now, the population has never been mapped. Fig. 5 – The Mapping System in Klaipeda
All involved participants and groups has their role and interest and the achieving of the results depends on their participation. The LSGs have already started working on the three lines of intervention and they have identified the crucial point to address in the transfer of the good practice of Udine. Here, below a summary of the main results coming from the LSGs work: 1. City Health Profile and GIS mapping It is worth noting that Klaipeda has already developed a GIS system mapping of some existing services and activities, such as green areas, bicycle trucks, public toilets, physical activities (fig. 4 and 5).
The interest of the stakeholders in this line of intervention consists of setting up new maps on the distribution of elderly population to overlap to the existing maps in order to provide policy makers with useful information for decision-making. Moreover new maps should be prepared on some specific activities of elderly people: eg., their occupational activities. Last 17 March 2014 a first discussion with GIS specialists started in Klaipeda with respect to the effective possibility to implement population age mapping in the City. A first contact with the expert of Udine for the GIS, prof. Fornasin, was established and the format for the implementation of GIS system shared with the partners. A first draft of a population age map is foreseen for next September 2014. At that date a number of population maps, not fixed yet, will be provided for policy makers who are effectively supporting the transfer of this good practice. The GIS system implementation will need adequate assessment. It is described below in next pages in more detail. 2. Vancouver Protocol
Fig. 4 – The home page of the Mapping System in Klaipeda
Klaipeda is also interested in the transfer of the methodology of the Vancouver Protocol for a more precise and effective assessment of elderly people needs in a life-course approach. The aim of the City is to identify the crucial point to realize an AgeFriendly City. The idea is to involve both elderly people and specialists, politicians and other professionals on the main problems, threats, but also solutions and suggestions to take into account for planning a more Healthy and Age-Friendly City. about criteria of Age
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The WHO Age-Friendly City criteria are willing to be integrated into the current Strategic Development Plan of the City. This is a very important step towards the embedding of Healthy and Age-Friendly City criteria within a wider strategy of action. It mean to adopt a more integrate model of governance where interventions are not scattered or isolated but embedded in wider Action Plan. 3. Preventative actions - Projects to remain mentally and physically active – Klaipeda is particularly interested in the implementation of the Project of Walking Groups. All these activities will required monitoring and evaluation. Monitoring will be focused on indicators of effectiveness in the implementation and transfer of the good practice at the local level. Public health specialists (workers from Klaipeda city municipality Public Health Bureau) will be responsible for the monitoring activity. Local Support Group members will be mainly responsible for the evaluation process. They will check:
The number of activities implemented; The opinion and satisfaction of elderly people participating in the activities transferred; The opinion of specialists, politicians, and other target groups on the results reached; The number of elderly people participating in the activities; Levels of increasing in quality of life among elderly people groups; Collaboration between sectors on the local level; The capacity to disseminate the results reached at national level.
The evaluation approach is mainly based on the following tools:
Independent summative evaluation carried out by external experts; Ongoing learning evaluation by external expert (Klaipeda university, Faculty of Health Sciences) Self-evaluation
Stakeholders are fully involved in the evaluation process. Randomised control group and survey on recipients are planned also considering the availability of additional budget from Public Health Programme.
Innovative capacity The City Healthy Ageing Profile (HAP) and the GIS mapping represents the two main key points of interest for Klaipeda in terms of innovative capacity. The commitment of the City on such an issue is well known, as it has already developed a mapping system of services at local level. The innovative aspect relies actually on the possibility of mapping elderly people distribution on the territory of the Municipality. There are also other innovative activities of interest for Klaipeda such as the adoption of the Vancouver Protocol and the Project of Walking Groups. All the actors involved are open and strongly motivated to implement new capacities
Funding At EU level, Klaipeda is looking for funds for the implementation of selected activities. Moreover, the successful implementation of the project and an adequate dissemination of the results may help the Municipality to obtain funds from the regional authorities or from the Lithuanian Ministry of Social Assistance and Labour. In fact, the City can count on Regional funds, as a committee of Klaipeda region has funds for specific lines of intervention. At Municipality level there is a budget line dedicated to the Local Public health programme. This could be another source for funding. Klaipeda Municipality will contribute at up to 20% of the costs incurred to implement the project activities. The staff of the Project is also looking for sponsors that could contribute on further funding specific activities.
Success factors and lessons learned The success factors of Udine will be good example for Klaipeda to implement new activities. At the moment, differently from Brighton and Edinburgh, in Klaipeda the political commitment is low but the city partners involved in the project trust in the possibility to motivate politicians in building a Healthy and Age-Friendly City starting from the experience of Udine. The personal and direct involvement of the Mayor of Udine in the development of the Project will represent a strength point for the success of the project because other local politicians, looking at their peer, will be motivated to do their best for succeeding in transfer.
40
A further success factor lacking, at the moment, in Klaipeda concerns the integrated model of governance. In fact, the city partners have pointed out that collaboration among local public bodies, NGOs and other local actors is frail. Anyway, Klaipeda seem having experience in managing European project and paying special attention to communication and dissemination strategies. This is a very crucial point that should be considered at every step of the project.
Transfer conditions With respect to the transfer of the practice concerning the City Health Profile and the GIS the following steps will be run: 1. adoption of the WHO methodology (Guidance for producing local Health Profiles); 2. check of the feasibility of building the 22 indicators in the WHO list; 3. check of the feasibility to map elderly population distribution on the territory of Gran Poitiers; 4. check of data availability and review of data sources at the local level; 5. involvement of the expert that the staff of Klaipeda has already identified as key actor of this transfer action. In fact, Klaipeda has already implemented the GIS with respect to a number of social and health services in the City. What is lacking is the matching of these information with the elderly people distribution on the territory of the Municipality. A first meeting has been already done last 17 March; 6. consultancy with the staff of the University of Udine to plan data organisation for building maps (the Klaipeda experts are already in contact with Prof. Fornasin of the University of Udine); 7. production of both population and WHO indicators for matching information by mapping by September 2014; 8. Reporting; 9. Assessment by Udine staff and Lead Expert (in itinere and ex post evaluation) With respect to the transfer of the Vancouver Protocol methodology the steps to be followed are shown below: 1. adoption of the WHO methodology (Age Friendly City Guide) accompanied by the Udine Report on “The health profile of elderly people in Udine”; 2. building groups engaging the LSG members in finding out how to get elderly people involved;
3. identification of volunteers with the expertise needed for the conduction of the focus groups; 4. conduction of the focus groups; 5. reporting activities according to the standard fixed by WHO; 6. assessment of the work done on the basis of the guidelines indicated by the Who guide but also through the following tools: o Independent summative evaluation carried out by external experts; o Ongoing learning evaluation by external expert (Klaipeda university, Faculty of Health Sciences) o Self-evaluation According to the third line of intervention focused on preventative actions aimed at enable elderly people to remain mentally and physically active, Klaipeda has agreed to transfer the practice of the “Walking Groups”, following the steps described below: 1. 24th March 2014 – a first meeting with associations of elderly people has been planned. In that occasion the “Walking group” activity will be presented to those who will attend the meeting; 2. 7th April 2014 – in occasion of the WHO Health Day the first “Walking Group” will start. By September a first monitoring of the ongoing process will be carried out.
Methodology for transferring activities at local level 41 Methods and techniques for
The “Vancouver Protocol”
transfer
a)
have
been
provided
with
the
Guidelines
of the WHO explaining the steps to follow to build the 22 indicators needed to define the City Health Profiles. The Guidelines have been described in detail during the first “Study Visit” in Udine (5-7 March). In order to get results with respect to this activity the direct engagement of the Statistical Offices operating at local level is recommended. The partners have already invited the local Statistical Offices to joining the Local Support Groups to enhance a more effective cooperation. Two out of four cities have already developed at local level experiences in mapping services and also population (Brigthon & Hove and Klaipeda);
b)
c)
b)
will be offered through: visits (two visits of prof. Fornasin have already been planned in Klaipeda and Grand Poitiers; Fiorenza Deriu has just come back from a visit to Brighton (8-9 April) to present the Urbact project to the Steering group meeting on Healthy Ageing and to keep in touch with the director of Health Department to reinforce the support to the Local
Support
conferences
Group);
c)
with
Partners have been provided with a
the
check
the participants into the focus groups; for drafting the tracks to conduct the focus groups. Brighton has already started this activity: during the visit the Lead expert has discussed with the Steering group the track prepared for the focus group on “Housing”, the first issue that will be addressed by the City. In order to favour the engagement of people in this
activity,
communication
events
d)
have been recommended. During the first Transnational Exchange Thematic Meeting that will be held in Klaipeda from 16th to 18th of June, partners will be invited to discuss and plan a communication event. The communication events will be organized by each city at the local level; they may have different forms: seminars, workshops, miniconferences and they will be focused on the experience of exchange with the other cities on the Healthy Ageing issue; Partners will be provided with the assistance of expertise from the Udine staff responsible for the Vancouver Protocol implementation. The assistance will be offered through:
visits
and/or video conferences with dott. Gianna Zamaro and Stefania Pascut responsible at local level for the management of the activities related to the focus group conduction;
video
with the lead expert to monitor the ongoing process and overcome difficulties.
provided
list including the criteria to follow for recruiting
Partners will be provided with a check list including all the activities required to build the City Health Maps. The check list will include the types of data to collect in order to build the population indicators as well as for mapping the services on the territory; Partners will be provided with the assistance of expertise from the Udine staff responsible for GIS system implementation. The assistance
been
of the WHO, explaining the steps to follow to build and carry out the focus groups needed to engage elderly people and social actors in the identification of priorities of intervention with regard to the following 8 thematic areas: housing, social participation, respect and social inclusion, civic participation and employment, communication and information, community support and health services, outdoor spaces and buildings, transportation. The Guidelines have been described in detail during the first “Study Visit” in Udine (5-7 March).
City Health Profiles and City Health Maps (GIS) Partners
have
Guidelines
In order to favour and sustain the best transfer of the activities part of this pilot transfer network, the partners will be provided with, and will adopt the following methodologies within each work package:
a)
Partners
e)
Videoconferences
with the lead expert to monitor the ongoing process and overcome difficulties. Two videoconferences
will be agreed in advance with the LE according to each partner needs. As an example: starting from the checklist provided by the LE, each city will identify the most critical steps, on which a discussion with the LE is considered useful. Moreover, further contacts and videoconferences may be agreed with the Lead Expert to discuss about problems coming up during the project.
42
Micro-projects to remain older people mentally and physically active a)
Partners have been provided with
specific
Guidelines, described and discussed during the first Study Visit in Udine (5-7 March). In that occasion partners have identified the aspects of major interest to consider at local level for transfer. It must be considered that cities such as Edinburgh and Brighton have already implemented a wide number of services at local level which are very similar to those working in Udine. Anyway, they are interested in identifying innovative ideas for a wider engagement of older people. As an example, during the recent
visit of the
Lead Expert
b)
to Brighton, the Steering group has put on the floor many questions about the implementation in Udine of the “Urban gardens” because this initiative is not so effective in their city if compared to the results got in Udine. The common discussion enabled the participants to identify a few new ideas to experiment at local level for improving this activity (reducing the area of each plot, eliminate the boundaries, favour the contact among tenants of the allotments, the adoption of an intergenerational approach based on the involvement of schools in caring plots). Partners have been provided with
evaluation and observational tools already tested on the projects
c)
implemented in Udine (e.g. “Move your minds--minds on the move”). A wider use of these tools can increase the confidence and feasibility of these tools in monitoring the activities transferred. Partner will be provided with the assistance of expertise from the Udine staff responsible for the Micro-projects implementation. The assistance will be offered through:
conferences
video
with dott. Laura Pagani
(University of Udine), Donatella Basso and Antonietta Zanini (Faculty of Nursing Studies), Stefania Pascut responsible at local level for the management of the activities related to the micro-projects development; d)
Videoconferences
with the Lead Expert to monitor the ongoing process and overcome difficulties. Two videoconferences will be agreed in advance with the LE according to each partner needs. Moreover, further contacts and videoconferences may be agreed with the Lead Expert to discuss about problems coming up during the project.
These are the methodologies that will be adopted at a very operative level to get results in a more effective way. Anyway, the following methodologies for transfer will be adopted in a mainstreamed approach to favour the exchange of experiences among partners and the transfer of ideas from the giving city to the partner and viceversa.
1. A Study Visit in the Giving City All receiving cities have attended a full 3 days Study Visit in Udine (5-7 March). Udine has presented in details the good practice, the activities that have been successfully implemented as well as the organization structure and the specific bodies that are responsible for its implementation. Local experts, such as prof. Fornasin, Laura Pagani, Gianna Zamaro, Stefania Pascut, Donatella Basso and Antonietta Zanini, have been introduced to partners in order to favour their future exchange and relationships. In that occasion experts have provided partners with their insight on the success of the good practice.
Two working groups have given partners the opportunity to reflect on the activities to focus on for transfer. The discussion in plenary with the lead expert has provided useful suggestions to plan the future work. 2. Local Support Meetings
Group
All receiving cities have already set up a Local Support Group of stakeholders that are working with the Municipality in the validation and the adaptation process of the good practice at local level. The LSGs will play an active role in the organization of the Peer-Review visits as well as in keeping the transfer log of the project for their city. At the starting
43
point of the project, all the receiving cities had already a LSG working at municipal level. Anyway, during the kick-off meeting in Paris, the partners were invited to make up a more in depth analysis of the actors to involve in the project (primary and secondary stakeholders), in order to increase the probability of success of the transfer network. At the moment, all the receiving cities have integrated their LSGs with new participants. The LSGs have already started their work and they are meeting once a month on average.
3. Lead Expert visit to the LSGs The Lead expert will visit the LSGs in order to present to the stakeholders engaged at the local level of the Urbact Programme, the “Healthy Ageing” Project and to discuss with them how to overcome obstacles to transfer or giving insights on specific activities to implement. The visits are also aimed at sensitizing politicians and public manager to support the experience of transfer of this network. The Lead Expert has already visited Brighton & Hove (8-9 April). On that occasion she has attended the meeting of the Steering Group on “Age Friendly City” (Room 431 King’s House) managed by Annie Alexander presenting the Urbact Programme (in general) and showing in details the activities the good practice of Udine is made of. The presentation has given the floor to a wide and useful discussion. Then, according to the implementation of the Vancouver Protocol the LSG has discussed the step forward to the City assessment on transportation and housing as well as on Dementia needs. Other toìime slots have been dedicated to discuss the Big Lottery Bid, an opportunity for financing some activities of the Urbact Project. A meeting with Dr Tom Scanlon, the Director of Public Health has followed, in order to motivate him to support stronger the work of the group on this project.
4. Peer-Review visits in the receiving cities within Transnational Thematic Meetings The receiving cities will organize a 2 and half a day peer review visit in their city. Brighton & Hove and Edinburgh will jointly organize their peer-review visit. Edinburgh will host the event. The aim of these visits will concern the presentation of the level of transfer of the good practice in each city; the discussion about the constraints and obstacles encountered; the exchange of comments and advices from the other project partners, including
the “giving city” and from other thematic expert, invited ad hoc. The first Peer-review meeting will be held in Klaipeda in June (17-19) and it will focus on preventative services; the second will be held in October in Edinburgh and it will focus on citizens engagement and prevention services for active ageing; the third meeting will be host by Grand Poitiers in January 2015 and it will focus on intergenerational approach policies for active ageing. The choice of an issue to develop during the visit is aimed at developing specific aspects of the topic and providing concrete methodological tools for better transfer and implementation of the good practice. These meetings will bring together “receiving cities” with the “giving city”, with the participation of experts that were involved in the implementation of the practice. These meetings will give the partners the opportunity to meet the local experts assisting them in the operative aspects of the transfer of the activities.
During the Peer-review a time slot will be reserved to the following monitoring activities: a) Submission of a monitoring grid to partners. The grid will include a number of qualitative and quantitative indicators (see next paragraph) on the results reached at that moment according to each work package; b) Swot analysis followed by a plenary discussion on solutions aimed at problem solving.
5. The Project Diary: the story of a transfer experience Starting from the beginning of February the Lead Expert has provided the partners with a template of a Project Diary to be used to track all the activities implemented to transfer the good practice of Udine at local level. Every three months the partners have to send the Diary to the LE who will draft a Newsletter where the steps of each city will be summarized, outlining the results already got, the obstacles encountered, the solutions adopted to overcome difficulties, and so on… The project Diary, at the end of the project will be used to summarize the main results reached and to draft a sort of Guideline for Good Transfer, with suggestions and lessons learned.
6. Site visits 44
In occasion of each peer-review visit the “receiving city” hosting the meeting will plan the visit to services, centres, as well as to associations or the participation into activities offering the other city partners the opportunity to know better how managing “Healthy Ageing” initiatives.
7. Project Workshops Each City partner is invited to organize at least one workshop at Municipal level to reflect on the best ways to transfer at local level the good practice of Udine. The Project workshops could be the occasion to invite the experts of the staff of Udine or the Lead expert to discuss more in depth the activities to develop for good transferring of the experience of Udine.
Finally, all these activities will be supported by mail communications, phone calls, and specific internet tools as Trello, Yummer or Dropbox, aiming at facilitating the establishment of a continuous dialogue among partners. As an example, a dropbox dedicated to the project has already been created as well as a site for to the collection and sharing of photos, videos and so on…
Project and activities assessment 45
According to the main lines of transfer described above the following indicators have been identified to assess the achievement of the results expected:
I)
Number of focus groups carried out – and on which issue
J)
Number of issues addressed – Type of issues addressed
K)
Number of project funded on the basis of the results got with transfer
L)
Amount of extra-funding transferring activities
AT PROJECT LEVEL City Health Profiles and City Health Maps (GIS) A) B) -
Number of cities implementing City Health Profile indicators Da 1 a 10 Da 11 a 15 Da 16 a 22 Number of cities implementing integrated GIS Health Maps with local services Up to 3 maps 4 maps 5 maps 6 and more maps
C)
Number of cities publishing Health Maps on websites already existing
D)
Satisfaction of politician/public managers/Managing authorities with the adoption of the City Maps – Did they use the Health Maps in decision making? Were the maps useful to identify possible solutions to resources allocation?
E)
Satisfaction of stakeholders with the adoption of Health Maps – Were the maps useful to identify possible solutions to older people needs? Were the maps useful to reach older people at risk of exclusion?
Satisfaction levels in D and E will be captured through qualitative interviews to key actors according to a track of interview that will be provided by the LE.
The “Vancouver Protocol” F)
Number of cities adopting the Vancouver Protocol
G)
Number of associations involved in focus groups
H)
Number of older people involved in focus groups
allocated
for
Micro-projects to remain older people mentally and physically active M) Number of cities implementing micro-projects N)
Number of cities that have used the experience of Udine to improve similar services already existing at local level
O)
Description of innovative solutions adopted to improve similar services already existing at local level
P)
With respect to the micro-project: “Move your minds…minds on the move”, report:
-
The level of the good practice transferred Amount of funding allocated Communication tools used
Q)
With respect to the micro-project: “Urban Gardens”, report:
-
The level of the of the good practice transferred Amount of funding allocated Communication tools used
R)
With respect to the micro-project: “Walking groups”, report:
-
The level of the of the good practice transferred Amount of funding allocated Communication tools used
Considering the short life of the project, it will not possible to evaluate the impact of the initiatives transferred, but it will be possible:
a) To describe changes in decision making in light of the new tools available to public managers (health maps); b) To describe the changes in older people “sentiment” with respect to the city administration, in light of the engagement in the focus groups for rising problems and identifying priorities in interventions; c) To describe the innovations introduced thanks to the transfer experience; d) To list 3 lessons learned at project level
46
Micro-projects to remain older people mentally and physically active K)
With respect to the micro-project: “Move your minds…minds on the move”, report:
-
Number of students involved in intergenerational projects Number of seminars organized Number of older people attending on average the seminars Number of associations involved in the management of this activity % of good practice transferred Amount of funding allocated
-
AT PARTNER LEVEL
-
City Health Profiles and City Health Maps (GIS)
Pre and post-test questionnaire
A)
Number City implemented
will be feasible for evaluate this specific microproject.
B)
Number of population implemented
C)
Number of GIS integrated maps (population and services) - minimum 3 maps
Health
Profile
GIS
indicators
Health
Maps
D)
Satisfaction with expertise exchange
E)
Satisfaction with other city representatives exchange
F)
Satisfaction with communication and sharing information system among partners
During each Transnational Exhange Meeting a self evaluation questionnaire will be submitted to partners by the LE in order to monitor the ongoing transfer process and to register the feasibility of the tools used for supporting partners in their activities.
The “Vancouver Protocol” G)
Number of associations involved in focus groups
H)
Number of older people involved in focus groups
I)
Number of focus groups carried out – and on which issue
J)
Number of issues addressed – Type of issues addressed
An Observational grid is available as well at the same goal (to study members relationships dynamics within the groups attending the seminars) L)
With respect to the micro-project: “Urban Gardens”, report:
-
Number of plots created Number of people involved Adoption of innovative solutions applied to existing services – Description of innovative solutions adopted to improve similar services already existing at local level % of good practice transferred Amount of funding allocated
-
M) With respect to the micro-project: “Walking groups”, report: -
-
Number of people attending the initiative Adoption of innovative solutions applied to existing services – Description of innovative solutions adopted to improve similar services already existing at local level The level of the good practice transferred Amount of funding allocated
Monitoring process and final evaluation Qualitative and quantitative data needed for building the indicators listed above will be collected both in occasion of the three Peer-
Review visits/TEM in order to monitor the process of transfer ongoing at the local level and one month before the final conference.
47
The following tools will be used to collect data: a)
Monitoring grid. This grid, edited by the LE of the project, will be submitted to partners in occasion of the three peerreview visits and it will be the occasion for the LE to know more in detail the results got at that moment by each city. The grid will be made of two sections, each one divided in two parts: one on quantitative information and the other dedicated to get qualitative information. The grid will be also used at the end of the project to evaluate the overall results achieved by partners;
b)
Swot Analysis Table. This table will be used during the three peer-review visits in working group sessions, where cities will work on their own analysing problems and constraints that could hinder a successful transfer of the good practice of Udine. They will be also invited to identify possible solutions. This exercise will represent a crucial part of the monitoring process of the transfer activity. It will enable partners to increase their awareness about the effective possibility to achieve successful results in transfer. Moreover, the discussion and the reciprocal exchange of experiences with other partners will sustain the motivation in problem solving, also identifying innovative ideas and solutions.
Considering the short life of the project, it will not be possible to evaluate the impact of the initiatives transferred, but it will be possible: a) To describe changes in decision making in light of the new tools available to public managers (health maps); b) To describe the changes in older people “sentiment” with respect to the city administration, in light of the engagement in the focus groups for rising problems and identifying priorities in interventions; c) To describe the innovations introduced thanks to the transfer experience; d) To list 3 lessons learned at partner level
References 48
Brighton & Hove JSNA (2913), Ageing Well, available at www.bhlis.org/jsna2013 Brighton University (2012), Well-being in old age: findings from participatory research”, Brighton & Hove Age UK/University of Brighton Brighton & Hove (2010), Annual Report on Public Health, Director of Public Health Caselli, Graziella and Viviana Egidi. 2011. “Una via più lunga e più sana,” in Antonio Golini and Alessandro Rosina (eds) Il secolo degli anziani. Come cambierà l’Italia. Il Mulino, Prismi, Bologna, pp. 29-45. Crimmins, Eileen M., Samuel H. Preston, and Barney Cohen. 2011. Explaining Divergent Levels of Longevity in High-Income Countries. Washington, D.C., The National Academic Press. Christensen, Koare, Gabriele Doblhammer, Ronald R. Rau, and James W. Vaupel. 2009. “Ageing populations: the challenges ahead.” Lancet 374, 9696, 1196-1208. PubMed ID: 19801098. Deriu, Fiorenza. 2011. “The emerging social and economic impact of population ageing in Europe: a focus on the SEE countries.” Opening lecture to the South Esatern Europe Home-care conference on Promoting active ageing, social inclusion and raising awareness for the necessity of home-care services. Montenegro and Austrian Red Cross. Sutomore (Montenegro). Gaymu, Joëlle, Patrick Festy, Michel Poulain and Gijs Beets. 2008. Future Elderly Living Conditions in Europe. L’Avenir des Conditions de Vie des Européens Agés. Les Cahiers de l’INED, Paris, INED. Hemerijck A. (2013), Retrenchment Policies and the deficit of Social Europe, Sociologica Live Well in Later Life, Edinburgh’s Joint Commission Plan for Older People 2012-2022 Luy, Marc, Christian Wegner and Wolfgang Lutz. 2011. “Adult Mortality in Europe.” In Richards G. Rogers, and Eileen M. Crimmins (eds), International Handbook of Adult Mortality, Springer, pp. 49-81. Meslé, France and Jacques Vallin. 2011. “Historical Trends in Mortality,” in Richards G. Rogers, and Eileen M. Crimmins (eds), International Handbook of Adult Mortality, Springer, pp.9-47. National Research Council. 2001. Preparing for an Ageing World. The case for cross-national research. Washington D.C., National Academy Press. Oeppen, Jim and James W. Vaupel. 2002. “Broken limits to life expectancy.” Science 296, 1029-1031. PubMed ID: 12004104. [ HTML | PDF ] Plouffe L., Kalache A. (2010), Towards global Age-Friendly Cities. Determining Urban Features tha Promote Active Ageing in: Journal of Urban Health, 87(5): 733-739 Windle K., Francis J., Coomber C. (2011), Preventing loneliness and social isolation: interventions and outcomes, Social care Institute for Excellence. Rau, Roland, Eugeny Soroko, Jasilionis Domantas and James W. Vaupel. 2008. “Continued reductions in mortality at advanced ages.” Population and Development Review 34: 747-768. Reshaping Care for Older People (2010-2021 Strategy) – Edinburgh Scotland’s National Dementia Strategy (2013-2016) – Edinburgh Strategic Plan for Klaipeda City 2020, available at www.klaipeda.lt/eng/The-strategic-plan/2496
49
Further information on data sources This baseline study relies on data and information collected during two Study Visits in Udine: a. Study Visit in Udine 26-28 February 2014 (with the participation on 27 February of Eddy Adams, Thematic Pole Manager of the Programme) b. Study Visit with Partner Cities 5-7 March 2014 The speakers of these two meetings are listed below: Speakers Furio Honsell Geoff Green (Expert from WHO) Gianna Zamaro Laura Pagani (Professor of the University of Udine – Statistician) Alessio Fornasin (Professor of the University of Udine – Demographer) Stefania Pascut Miriam Totis Andrea Romanini Bruno Grizzaffi Ennio Furlan (Representatives of the Municipality in charge for implementing Urban Gardens in Udine) Furio Honsell
Guido De Michielis Saverio Ambesi Antonietta Zanini Students Mary Ann McCoy Anna Sostero
Walking Group members
Paolo Munini Donatella Basso
Topics General overview on the policy strategy of the Municipality of Udine WHO Healthy Ageing Sub-Network activity Healthy Ageing Profile e introduzione DECiPHEr Project “DECiPHEr” - training evaluation tool
GIS mapping and Health maps
Presentation of the Vancouver Protocol Visit to the City Gardens – via Pellis
Presentation of the experiences aimed at promoting opportunities for older people to remain physically, mentally and socially active Association Alzheimer Udine onlus Involvement of the University in “Move your minds…minds on the move” (intergenerational approach) Interviews to the organisers, students, participants by the Lead Expert Video CamminaMenti Meeting with a “Walking Group”, Buffet with typical organic products, Interviews to the organisers and participants Visit to the “Ludoteca” Move your minds…minds on the move
Most of the lectures and interviews have been recorded A photo gallery of the Visits was got
URBACT is a European exchange and learning programme
promoting
sustainable
urban
development. It enables cities to work together to develop solutions to major urban challenges, reaffirming the key role they play in facing increasingly complex societal challenges. It helps them to develop pragmatic solutions that are new and sustainable, and
that
integrate
economic,
social
and
environmental dimensions. It enables cities to share good practices and lessons learned with all professionals involved in urban policy throughout Europe. URBACT is 181 cities, 29 countries, and 5,000 active participants
www.urbact.eu/project
